Device and method for asissting laparoscopic surgery - rule based approach

ABSTRACT

A surgical controlling system comprising: at least one surgical tool insertable into a surgical environment of a body; a means to real-time locate 3D spatial positions of the surgical tools at any time t, in communication with a movement detection means and a movement database; a controller having a processing means in communication with a controller database and the movement detection means; and an endoscope, either one of the tools or in addition to them, to provide a real-time image of the surgical environment. The movement database stores the 3D spatial positions of the surgical tools at times t f  and t 0 . A surgical tool has moved if its 3D spatial position at time t f  differs from its position at time to. The controller database stores rules used by the controller to control the spatial positions of the surgical tools; the rules determine ALLOWED and RESTRICTED movements of the surgical tools.

FIELD OF THE INVENTION

The present invention generally relates to means and methods forimproving the interface between the surgeon and the operating medicalassistant or between the surgeon and an endoscope system forlaparoscopic surgery. Moreover, the present invention discloses a deviceuseful for spatially repositioning an endoscope to a specific region inthe human body during surgery.

BACKGROUND OF THE INVENTION

In laparoscopic surgery, the surgeon performs the operation throughsmall holes using long instruments and observing the internal anatomywith an endoscope camera. The endoscope is conventionally held by ahuman camera assistant (i.e. operating medical assistant) since thesurgeon must perform the operation using both hands. The surgeon'sperformance is largely dependent on the camera position relative to theinstruments and on a stable image shown by the monitor. The main problemis that it is difficult for the operating medical assistant to hold theendoscope steady, keeping the scene upright.

Laparoscopic surgery is becoming increasingly popular with patientsbecause the scars are smaller and their period of recovery is shorter.Laparoscopic surgery requires special training for the surgeon orgynecologist and the theatre nursing staff. The equipment is oftenexpensive and is not available in all hospitals.

During laparoscopic surgery, it is often required to shift the spatialplacement of the endoscope in order to present the surgeon with anoptimal view. Conventional laparoscopic surgery makes use of eitherhuman assistants that manually shift the instrumentation or,alternatively, robotic automated assistants. Automated assistantsutilize interfaces that enable the surgeon to direct the mechanicalmovement of the assistant, achieving a shift in the camera view.

U.S. Pat. No. 6,714,841 discloses an automated camera endoscope in whichthe surgeon is fitted with a head mounted light source that transmitsthe head movements to a sensor, forming an interface that converts themovements to directions for the mechanical movement of the automatedassistant. Alternative automated assistants incorporate a voice operatedinterface, a directional key interface, or other navigationalinterfaces. The above interfaces share the following drawbacks:

-   -   a. A single directional interface that provide limited feedback        to the surgeon.    -   b. A cumbersome serial operation for starting and stopping        movement directions that requires the surgeon's constant        attention, preventing the surgeon from keeping the flow of the        surgical procedure.

Research has suggested that these systems divert the surgeon's focusfrom the major task at hand. Therefore, technologies assisted by magnetsand image processing have been developed to simplify interfacingcontrol. However, these improved technologies still fail to addressanother complicating interface aspect of laparoscopic surgery, in thatthey do not allow the surgeon to signal, to automated assistants or tohuman assistants or to surgical colleagues, which instrument hisattention is focused on.

Hence, there is still a long felt need for a improving the interfacebetween the surgeon and an endoscope system, surgical colleagues orhuman assistants for laparoscopic surgery.

SUMMARY OF THE INVENTION

It is one object of the present invention to provide a surgicalcontrolling system, comprising:

-   -   a. at least one surgical tool adapted to be inserted into a        surgical environment of a human body for assisting a surgical        procedure;    -   b. at least one location estimating means adapted to real rime        locate the 3D spatial position of the at least one surgical tool        at any given time t;    -   c. at least one movement detection means communicable with a        movement's database and with said location estimating means;        said movement's database is adapted to store said 3D spatial        position of said at least one surgical tool at time t_(f) and at        time t₀; where t_(f)>t₀; said movement detection means is        adapted to detect movement of said at least one surgical tool if        the 3D spatial position of said at least one surgical tool at        time t_(f) is different than said 3D spatial position of said at        least one surgical tool at time t₀; and,    -   d. a controller having a processing means communicable with a        controller's database, the controller adapted to control the        spatial position of the at least one surgical tool; said        controller's database is in communication with said movement        detection means;    -   wherein the controller's database is adapted to store a        predetermined set of rules according to which ALLOWED and        RESTRICTED movements of the at least one surgical tool are        determined, such that each detected movement by said movement        detection means of said at least one surgical tool is determined        as either an ALLOWED movement or as a RESTRICTED movement        according to said predetermined set of rules.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the predetermined set ofrules comprises at least one rule selected from a group consisting of:most used tool rule, right tool rule, left tool rule, field of viewrule, no fly zone rule, route rule, environmental rule, operator inputrule, proximity rule; collision prevention rule, history-based rule,tool-dependent allowed and RESTRICTED movements rule, preferred volumezone rule, preferred tool rule, a movement detection rule, tagged toolrule, change of speed rule and any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the route rule comprises acommunicable database storing predefined route in which the at least onesurgical tool is adapted to move within the surgical environment; thepredefined route comprises n 3D spatial positions of the at least onesurgical tool; n is an integer greater than or equals to 2; the ALLOWEDmovements are movements in which the at least one surgical tool islocated substantially in at least one of the n 3D spatial positions ofthe predefined route, and the RESTRICTED movements are movements inwhich the location of the at least one surgical tool is substantiallydifferent from the n 3D spatial positions of the predefined route.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the environmental rulecomprises a comprises a communicable database; the communicable databaseis adapted to received real-time image of the surgical environment andis adapted to perform real-time image processing of the same and todetermine the 3D spatial position of hazards or obstacles in thesurgical environment; the environmental rule is adapted to determine theALLOWED and RESTRICTED movements according to the hazards or obstaclesin the surgical environment, such that the RESTRICTED movements aremovements in which the at least one surgical tool is locatedsubstantially in at least one of the 3D spatial positions, and theALLOWED movements are movements in which the location of the at leastone surgical tool is substantially different from the 3D spatialpositions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the hazards or obstacles inthe surgical environment are selected from a group consisting of tissue,a surgical tool, an organ, an endoscope and any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the operator input rulecomprises a communicable database; the communicable database is adaptedto receive an input from the operator of the system regarding theALLOWED and RESTRICTED movements of the at least one surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the input comprises n 3Dspatial positions; n is an integer greater than or equals to 2; whereinat least one of which is defined as ALLOWED location and at least one ofwhich is defined as RESTRICTED location, such that the ALLOWED movementsare movements in which the at least one surgical tool is locatedsubstantially in at least one of the n 3D spatial positions, and theRESTRICTED movements are movements in which the location of the at leastone surgical tool is substantially different from the n 3D spatialpositions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the input comprises atleast one rule according to which ALLOWED and RESTRICTED movements ofthe at least one surgical tool are determined, such that the spatialposition of the at least one surgical tool is controlled by thecontroller according to the ALLOWED and RESTRICTED movements.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the predetermined set ofrules comprises at least one rule selected from the group consisting of:most used tool, right tool rule, left tool rule, field of view rule, nofly zone rule, a route rule, an environmental rule, an operator inputrule, a proximity rule; a collision prevention rule, preferred volumezone rule, movement detection rule, a history based rule, atool-dependent allowed and RESTRICTED movements rule, and anycombination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the operator input ruleconverts an ALLOWED movement to a RESTRICTED movement and a RESTRICTEDmovement to an ALLOWED movement.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the proximity rule isadapted to define a predetermined distance between at least two surgicaltools; the ALLOWED movements are movements which are within the range orout of the range of the predetermined distance, and the RESTRICTEDmovements which are out of the range or within the range of thepredetermined distance.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the proximity rule isadapted to define a predetermined angle between at least three surgicaltools; the ALLOWED movements are movements which are within the range orout of the range of the predetermined angle, and the RESTRICTEDmovements which are out of the range or within the range of thepredetermined angle.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the collision preventionrule is adapted to define a predetermined distance between the at leastone surgical tool and an anatomical element within the surgicalenvironment; the ALLOWED movements are movements which are in a rangethat is larger than the predetermined distance, and the RESTRICTEDmovements are movements which is in a range that is smaller than thepredetermined distance.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the anatomical element isselected from a group consisting of tissue, organ, another surgical toolor any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein at least one of thefollowing is being held true (a) said system additionally comprising anendoscope; said endoscope is adapted to provide real-time image of saidsurgical environment; (b) at least one of said surgical tools is anendoscope adapted to provide real-time image of said surgicalenvironment.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the right tool rule isadapted to determine the ALLOWED movement of the endoscope according tothe movement of the surgical tool positioned to right of the endoscope.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the left tool rule isadapted to determine the ALLOWED movement of the endoscope according tothe movement of the surgical tool positioned to left of the endo scope.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, said a tagged tool rule comprisesmeans adapted to tag at least one surgical tool within said surgicalenvironment and to determine said ALLOWED movement of said endoscopeaccording to the movement of said tagged surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the field of view rulecomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equals to 2; the combination of all of then 3D spatial positions provides a predetermined field of view; the fieldof view rule is adapted to determine the ALLOWED movement of theendoscope within the n 3D spatial positions so as to maintain a constantfield of view, such that the ALLOWED movements are movements in whichthe endoscope is located substantially in at least one of the n 3Dspatial positions, and the RESTRICTED movements are movements in whichthe location of the endoscope is substantially different from the n 3Dspatial positions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the preferred volume zonerule comprises a communicable database comprising n 3D spatialpositions; n is an integer greater than or equals to 2; the n 3D spatialpositions provides the preferred volume zone; the preferred volume zonerule is adapted to determine the ALLOWED movement of the endoscopewithin the n 3D spatial positions and RESTRICTED movement of theendoscope outside the n 3D spatial positions, such that the ALLOWEDmovements are movements in which the endoscope is located substantiallyin at least one of the n 3D spatial positions, and the RESTRICTEDmovements are movements in which the location of the endoscope issubstantially different from the n 3D spatial positions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the preferred tool rulecomprises a communicable database, the database stores a preferred tool;the preferred tool rule is adapted to determine the ALLOWED movement ofthe endoscope according to the movement of the preferred tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the no fly zone rulecomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equals to 2; the n 3D spatial positionsdefine a predetermined volume within the surgical environment; the nofly zone rule is adapted to determine the RESTRICTED movement if themovement is within the no fly zone and the ALLOWED movement if themovement is outside the no fly zone, such that the RESTRICTED movementsare movements in which the at least one of the surgical tool is locatedsubstantially in at least one of the n 3D spatial positions, and theALLOWED movements are movements in which the location of the at leastone surgical tool is substantially different from the n 3D spatialpositions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the most used tool rulecomprises a communicable database counting the amount of movement ofeach of the surgical tools; the most used tool rule is adapted toconstantly position the endoscope to track the movement of the mostmoved surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein said system furthercomprising a maneuvering subsystem communicable with said controller,said maneuvering subsystem is adapted to spatially reposition said atleast one surgical tool during a surgery according to said predeterminedset of rules; further wherein the system is adapted to alert thephysician of a RESTRICTED movements of the at least one surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the alert is selected froma group consisting of audio signaling, voice signaling, light signaling,flashing signaling and any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the ALLOWED movement ispermitted by the controller and a RESTRICTED movement is denied by thecontroller.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the history based rulecomprises a communicable database storing each 3D spatial position ofeach of the surgical tool, such that each movement of each surgical toolis stored; the history based rule is adapted to determine the ALLOWEDand RESTRICTED movements according to historical movements of the atleast one surgical tool, such that the ALLOWED movements are movementsin which the at least one surgical tool is located substantially in atleast one of the 3D spatial positions, and the RESTRICTED movements aremovements in which the location of the at least one surgical tool issubstantially different from the n 3D spatial positions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the tool-dependent allowedand RESTRICTED movements rule comprises a communicable database; thecommunicable database is adapted to store predetermined characteristicsof at least one of the surgical tool; the tool-dependent allowed andRESTRICTED movements rule is adapted to determine the ALLOWED andRESTRICTED movements according to the predetermined characteristics ofthe surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the predeterminedcharacteristics of the surgical tool are selected from the groupconsisting of: physical dimensions, structure, weight, sharpness, andany combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the movement detection rulecomprises a communicable database comprising the real-time 3D spatialpositions of each of the surgical tool; and to detect movement of the atleast one surgical tool when a change in the 3D spatial positions isreceived, such that the ALLOWED movements are movements in which theendoscope is directed to focus on the moving surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, further comprising a maneuveringsubsystem communicable with the controller, the maneuvering subsystem isadapted to spatially reposition the at least one surgical tool during asurgery according to the predetermined set of rules, such that if saidmovement of said at least one surgical tool is a RESTRICTED movement,said maneuvering subsystem prevents said movement.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the at least one locationestimating means comprises at least one endoscope adapted to acquirereal-time images of the surgical environment within the human; and atleast one surgical instrument spatial location software adapted toreceive said real-time images of said surgical environment and toestimate said 3D spatial position of said at least one surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the at least one locationestimating means are comprises (a) at least one element selected from agroup consisting of optical imaging means, radio frequency transmittingand receiving means, at least one mark on the at least one surgical tooland any combination thereof; and, (b) at least one surgical instrumentspatial location software adapted to estimate said 3D spatial positionof said at least one surgical tool by means of said element.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the at least one locationestimating means are an interface subsystem between a surgeon and the atleast one surgical tool, the interface subsystem comprises:

-   -   a. at least one array comprising N regular or pattern light        sources, where N is a positive integer;    -   b. at least one array comprising M cameras, each of the M        cameras, where M is a positive integer;    -   c. optional optical markers and means for attaching the optical        marker to the at least one surgical tool; and;    -   d. a computerized algorithm operable via the controller, the        computerized algorithm adapted to record images received by each        camera of each of the M cameras and to calculate therefrom the        position of each of the tools, and further adapted to provide        automatically the results of the calculation to the human        operator of the interface.

It is another object of the present invention to provide a method forassisting an operator to perform a surgical procedure, comprising stepsof:

-   -   a. providing a surgical controlling system, comprising: (i) at        least one surgical tool; (ii) at least one location estimating        means; (iii) at least one movement detection means; and, (iv) a        controller having a processing means communicable with a        controller's database;    -   b. inserting the at least one surgical tool into a surgical        environment of a human body;    -   c. real-time estimating the location of the at least one        surgical tool within the surgical environment at any given time        t; and,    -   d. detecting if there is movement of said at least one surgical        tool if the 3D spatial position of said at least one surgical        tool at time t_(f) is different than said 3D spatial position of        said at least one surgical tool at time t₀;    -   e. controlling the spatial position of the at least one surgical        tool within the surgical environment by means of the controller;    -   wherein the step of controlling is performed by storing a        predetermined set of rules in a controller's database; said        predetermined set of rules comprises ALLOWED and RESTRICTED        movements of the at least one surgical tool, such that each        detected movement by said movement detection means of said at        least one surgical tool is determined as either an ALLOWED        movement or as a RESTRICTED movement according to said        predetermined set of rules.

It is another object of the present invention to provide the method asdefined above, further comprising a step of selecting the predeterminedset of rules from the group consisting of: most used tool, right toolrule, left tool rule, field of view rule, no fly zone rule, a routerule, an environmental rule, an operator input rule, a proximity rule; acollision prevention rule, preferred volume zone rule, preferred toolrule, movement detection rule, a history based rule, a tool-dependentallowed and RESTRICTED movements rule, tagged tool rule and anycombination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the route rule comprises a communicable databasestoring predefined route in which the at least one surgical tool isadapted to move within the surgical environment; the predefined routecomprises n 3D spatial positions of the at least one surgical tool; n isan integer greater than or equals to 2; the ALLOWED movements aremovements in which the at least one surgical tool is locatedsubstantially in at least one of the n 3D spatial positions of thepredefined route, and the RESTRICTED movements are movements in whichthe location of the at least one surgical tool is substantiallydifferent from the n 3D spatial positions of the predefined route.

It is another object of the present invention to provide the method asdefined above, wherein the environmental rule comprises a comprises acommunicable database; the communicable database is adapted to receivedreal-time image of the surgical environment and is adapted to performreal-time image processing of the same and to determine the 3D spatialposition of hazards or obstacles in the surgical environment; theenvironmental rule is adapted to determine the ALLOWED and RESTRICTEDmovements according to the hazards or obstacles in the surgicalenvironment, such that the RESTRICTED movements are movements in whichthe at least one surgical tool is located substantially in at least oneof the 3D spatial positions, and the ALLOWED movements are movements inwhich the location of the at least one surgical tool is substantiallydifferent from the 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the hazards or obstacles in the surgicalenvironment are selected from a group consisting of tissue, a surgicaltool, an organ, an endoscope and any combination thereof

It is another object of the present invention to provide the method asdefined above, wherein the operator input rule comprises a communicabledatabase; the communicable database is adapted to receive an input fromthe operator of the system regarding the ALLOWED and RESTRICTEDmovements of the at least one surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the input comprises n 3D spatial positions; n isan integer greater than or equals to 2; wherein at least one of which isdefined as ALLOWED location and at least one of which is defined asRESTRICTED location, such that the ALLOWED movements are movements inwhich the at least one surgical tool is located substantially in atleast one of the n 3D spatial positions, and the RESTRICTED movementsare movements in which the location of the at least one surgical tool issubstantially different from the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the input comprises at least one predeterminedrule according to which ALLOWED and RESTRICTED movements of the at leastone surgical tool are determined, such that the spatial position of theat least one surgical tool is controlled by the controller according tothe ALLOWED and RESTRICTED movements.

It is another object of the present invention to provide the method asdefined above, wherein the predetermined rules is selected from thegroup consisting of: most used tool, right tool rule, left tool rule,field of view rule, no fly zone rule, preferred volume zone rule, aroute rule, an environmental rule, an operator input rule, a proximityrule; a collision prevention rule, a history based rule, atool-dependent allowed and RESTRICTED movements rule, and anycombination thereof

It is another object of the present invention to provide the method asdefined above, wherein the operator input rule converts an ALLOWEDmovement to a RESTRICTED movement and a RESTRICTED movement to anALLOWED movement.

It is another object of the present invention to provide the method asdefined above, wherein the proximity rule is adapted to define apredetermined distance between at least two surgical tools; the ALLOWEDmovements are movements which are within the range or out of the rangeof the predetermined distance, and the RESTRICTED movements which areout of the range or within the range of the predetermined distance.

It is another object of the present invention to provide the method asdefined above, wherein the proximity rule is adapted to define apredetermined angle between at least three surgical tools; the ALLOWEDmovements are movements which are within the range or out of the rangeof the predetermined angle, and the RESTRICTED movements which are outof the range or within the range of the predetermined angle

It is another object of the present invention to provide the method asdefined above, wherein the collision prevention rule is adapted todefine a predetermined distance between the at least one surgical tooland an anatomical element within the surgical environment; the ALLOWEDmovements are movements which are in a range that is larger than thepredetermined distance, and the RESTRICTED movements are movements whichis in a range that is smaller than the predetermined distance.

It is another object of the present invention to provide the method asdefined above, wherein the anatomical element is selected from a groupconsisting of tissue, organ, another surgical tool or any combinationthereof.

It is another object of the present invention to provide the method asdefined above, wherein at least one of the following is being held true(a) said system additionally comprising an endoscope; said endoscope isadapted to provide real-time image of said surgical environment; (b) atleast one of said surgical tools is an endoscope adapted to providereal-time image of said surgical environment.

It is another object of the present invention to provide the method asdefined above, wherein the right tool rule is adapted to determine theALLOWED movement of the endoscope according to the movement of thesurgical tool positioned to right of the endoscope.

It is another object of the present invention to provide the method asdefined above, wherein the left tool rule is adapted to determine theALLOWED movement of the endoscope according to the movement of thesurgical tool positioned to left of the endoscope.

It is another object of the present invention to provide the method asdefined above, wherein said a tagged tool rule comprises means adaptedto tag at least one surgical tool within said surgical environment andto determine said ALLOWED movement of said endoscope according to themovement of said tagged surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the field of view rule comprises n 3D spatialpositions; n is an integer greater than or equals to 2; the combinationof all of the n 3D spatial positions provides a predetermined field ofview; the field of view rule is adapted to determine the ALLOWEDmovement of the endoscope within the n 3D spatial positions so as tomaintain a constant field of view, such that the ALLOWED movements aremovements in which the endoscope is located substantially in at leastone of the n 3D spatial positions, and the RESTRICTED movements aremovements in which the location of the endoscope is substantiallydifferent from the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the preferred volume zone rule comprises acommunicable database comprising n 3D spatial positions; n is an integergreater than or equals to 2; the n 3D spatial positions provides thepreferred volume zone; the preferred volume zone rule is adapted todetermine the ALLOWED movement of the endoscope within the n 3D spatialpositions and RESTRICTED movement of the endoscope outside the n 3Dspatial positions, such that the ALLOWED movements are movements inwhich the endoscope is located substantially in at least one of the n 3Dspatial positions, and the RESTRICTED movements are movements in whichthe location of the endoscope is substantially different from the n 3Dspatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the preferred tool rule comprises a communicabledatabase, the database stores a preferred tool; the preferred tool ruleis adapted to determine the ALLOWED movement of the endoscope accordingto the movement of the preferred tool.

It is another object of the present invention to provide the method asdefined above, wherein the no fly zone rule comprises n 3D spatialpositions; n is an integer greater than or equals to 2; the n 3D spatialpositions define a predetermined volume within the surgical environment;the no fly zone rule is adapted to determine the RESTRICTED movement ifthe movement is within the no fly zone and the ALLOWED movement if themovement is outside the no fly zone, such that the RESTRICTED movementsare movements in which the at least one of the surgical tool is locatedsubstantially in at least one of the n 3D spatial positions, and theALLOWED movements are movements in which the location of the at leastone surgical tool is substantially different from the n 3D spatialpositions.

It is another object of the present invention to provide the method asdefined above, wherein the most used tool rule comprises a databasecounting the amount of movement of each of the surgical tools; the mostused tool rule is adapted to constantly position the endoscope to trackthe movement of the most moved surgical tool.

It is another object of the present invention to provide the method asdefined above, additionally comprising step of alerting the physician ofa RESTRICTED movements of the at least one surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the step of alerting is performed by at least oneselected from a group consisting of audio signaling, voice signaling,light signaling, flashing signaling and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the ALLOWED movement is permitted by thecontroller and a RESTRICTED movement is denied by the controller.

It is another object of the present invention to provide the method asdefined above, wherein the history based rule comprises a communicabledatabase storing each 3D spatial position of each of the surgical tool,such that each movement of each surgical tool is stored; the historybased rule is adapted to determine the ALLOWED and RESTRICTED movementsaccording to historical movements of the at least one surgical tool,such that the ALLOWED movements are movements in which the at least onesurgical tool is located substantially in at least one of the 3D spatialpositions, and the RESTRICTED movements are movements in which thelocation of the at least one surgical tool is substantially differentfrom the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the tool-dependent allowed and RESTRICTEDmovements rule comprises a communicable database; the communicabledatabase is adapted to store predetermined characteristics of at leastone of the surgical tool; the tool-dependent allowed and RESTRICTEDmovements rule is adapted to determine the ALLOWED and RESTRICTEDmovements according to the predetermined characteristics of the surgicaltool.

It is another object of the present invention to provide the method asdefined above, wherein the predetermined characteristics of the surgicaltool are selected from the group consisting of: physical dimensions,structure, weight, sharpness, and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the movement detection rule comprises acommunicable database comprising the real-time 3D spatial positions ofeach of the surgical tool; and to detect movement of the at least onesurgical tool when a change in the 3D spatial positions is received,such that the ALLOWED movements are movements in which the endoscope isdirected to focus on the moving surgical tool.

It is another object of the present invention to provide the method asdefined above, further comprising a step of providing a maneuveringsubsystem communicable with the controller, the maneuvering subsystem isadapted to spatially reposition the at least one surgical tool during asurgery according to the predetermined set of rules.

It is another object of the present invention to provide the method asdefined above, wherein the at least one location estimating meanscomprises at least one endoscope adapted to acquire real-time images ofa surgical environment within the human body; and at least one surgicalinstrument spatial location software adapted to receive said real-timeimages of said surgical environment and to estimate said 3D spatialposition of said at least one surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the at least one location estimating means arecomprises (a) at least one element selected from a group consisting ofoptical imaging means, radio frequency transmitting and receiving means,at least one mark on the at least one surgical tool and any combinationthereof; and, (b) at least one surgical instrument spatial locationsoftware adapted to estimate said 3D spatial position of said at leastone surgical tool by means of said element.

It is another object of the present invention to provide the method asdefined above, wherein the at least one location estimating means are aninterface subsystem between a surgeon and the at least one surgicaltool, the interface subsystem comprises:

-   -   a. at least one array comprising N regular or pattern light        sources, where N is a positive integer;    -   b. at least one array comprising M cameras, each of the M        cameras, where M is a positive integer;    -   c. optional optical markers and means for attaching the optical        marker to the at least one surgical tool; and,    -   d. a computerized algorithm operable via the controller, the        computerized algorithm adapted to record images received by each        camera of each of the M cameras and to calculate therefrom the        position of each of the tools, and further adapted to provide        automatically the results of the calculation to the human        operator of the interface.

It is another object of the present invention to provide a surgicaltracking system for assisting an operator to perform a laparoscopicsurgery of a human body, the surgical tracking system comprising:

-   -   a. at least one endoscope adapted to acquire real-time images of        a surgical environment within the human body;    -   b. a maneuvering subsystem adapted to control the spatial        position of the endoscope during the laparoscopic surgery; and,    -   c. a tracking subsystem in communication with the maneuvering        subsystem, adapted to control the maneuvering system so as to        direct and modify the spatial position of the endoscope to a        region of interest;    -   wherein the tracking subsystem comprises a data processor; the        data processor is adapted to perform real-time image processing        of the surgical environment and to instruct the maneuvering        subsystem to modify the spatial position of the endoscope        according to input received from a maneuvering function f(t);        the maneuvering function f(t) is adapted to (a) receive input        from at least two instructing functions g_(i)(t), where i is 1,        . . . , n and n≧2; where t is time; i and n are integers; and,        to (b) output instructions to the maneuvering subsystem based on        the input from the at least two instructing functions g_(i)(t),        so as to spatially position the endoscope to the region of        interest.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein each of the instructingfunctions g_(i)(t) is provided with α_(i)(t) where i is an integergreater than or equals to 1; where α_(i)(t) are weighting functions ofeach g_(i)(t), and a n is total number of instruction functions.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein each of the instructingfunctions g_(i)(t) is selected from a group consisting of: most usedtool function, a right tool function, left tool function, field of viewfunction, preferred volume zone function, preferred tool function, nofly zone function, a tool detection function, a movement detectionfunction, an organ detection function, a collision detection function,an operator input function, a prediction function, a past statisticalanalysis function, proximity function, a tagged tool function, and anycombination thereof.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the weighting functionsα_(i)(t) are time-varying functions, wherein the value of which isdetermined by the operators.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the tool detection function isadapted to detect surgical tools in the surgical environment and tooutput instruction to the tracking subsystem to instruct the maneuveringsystem to direct the endoscope on the detected surgical tools.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the movement detectionfunction comprises a communicable database comprising the real-time 3Dspatial positions of each of the surgical tool in the surgicalenvironment; and to detect movement of the at least one surgical toolwhen a change in the 3D spatial positions is received, and to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to direct the endoscope on the moved surgical tool.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the organ detection functionis adapted to detect organs in the surgical environment and to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to direct the endoscope on the detected organs.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the right tool function isadapted to detect surgical tool positioned to right of the endoscope andto output instructions to the tracking subsystem to instruct themaneuvering system to constantly direct the endoscope on the right tooland to track the right tool.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the left tool function isadapted to detect surgical tool positioned to left of the endoscope andto output instructions to the tracking subsystem to instruct themaneuvering system to constantly direct the endoscope on the left tooland to track the left tool.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the operator input functioncomprises a communicable database; the communicable database is adaptedto receive an input from the operator of the system; the inputcomprising n 3D spatial positions; n is an integer greater than orequals to 2; and to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to the at leastone 3D spatial position received.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the proximity function isadapted to define a predetermined distance between at least two surgicaltools; and to output instructions to the tracking subsystem to instructthe maneuvering system to direct the endoscope to the two surgical toolsif the distance between the two surgical tools is less than thepredetermined distance.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the proximity function isadapted to define a predetermined angle between at least three surgicaltools; and to output instructions to the tracking subsystem to instructthe maneuvering system to direct the endoscope to the three surgicaltools if the angle between the two surgical tools is less than orgreater than the predetermined angle.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the preferred volume zonefunction comprises communicable database comprising n 3D spatialpositions; n is an integer greater than or equals to 2; the n 3D spatialpositions provides the preferred volume zone; the preferred volume zonefunction is adapted to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to the preferredvolume zone.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the preferred tool functioncomprises a communicable database, the database stores a preferred tool;the preferred tool function is adapted to output instructions to thetracking subsystem to instruct the maneuvering system to direct theendoscope to the preferred tool.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the collision preventionfunction is adapted to define a predetermined distance between the atleast one surgical tool and an anatomical element within the surgicalenvironment; and to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to the surgicaltool and the anatomical element within the surgical environment if thedistance between the at least one surgical tool and an anatomicalelement is less than the predetermined distance.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the anatomical element isselected from a group consisting of tissue, organ, another surgical toolor any combination thereof.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the field of view functioncomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equals to 2; the combination of all of then 3D spatial positions provides a predetermined field of view; the fieldof view function is adapted to output instructions to the trackingsubsystem to instruct the maneuvering system to direct the endoscope toat least one 3D spatial position substantially within the n 3D spatialpositions so as to maintain a constant field of view.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the no fly zone functioncomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equals to 2; the n 3D spatial positionsdefine a predetermined volume within the surgical environment; the nofly zone function is adapted to output instructions to the trackingsubsystem to instruct the maneuvering system to direct the endoscope toat least one 3D spatial position substantially different from all the n3D spatial positions.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the most used tool functioncomprises a communicable database counting the amount of movement ofeach surgical tool located within the surgical environment; the mostused tool function is adapted to output instructions to the trackingsubsystem to instruct the maneuvering system to direct the endoscope toconstantly position the endoscope to track the movement of the mostmoved surgical tool.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the prediction functioncomprises a communicable database storing each 3D spatial position ofeach of surgical tool within the surgical environment, such that eachmovement of each surgical tool is stored; the prediction function isadapted to (a) to predict the future 3D spatial position of each of thesurgical tools; and, (b) to output instructions to the trackingsubsystem to instruct the maneuvering system to direct the endoscope tothe future 3D spatial position.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the past statistical analysisfunction comprises a communicable database storing each 3D spatialposition of each of surgical tool within the surgical environment, suchthat each movement of each surgical tool is stored; the past statisticalanalysis function is adapted to (a) statistical analyze the 3D spatialpositions of each of the surgical tools; and, (b) to predict the future3D spatial position of each of the surgical tools; and, (c) to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to direct the endoscope to the future 3D spatial position.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the a tagged tool functioncomprises means adapted to tag at least one surgical tool within thesurgical environment and to output instructions to the trackingsubsystem to instruct the maneuvering system to constantly direct theendoscope to the tagged surgical tool.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the means are adapted toconstantly tag the at least one of surgical tool within the surgicalenvironment.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein means are adapted to re-tagthe at least one of the surgical tools until a desired tool is selected.

It is another object of the present invention to provide the surgicaltracking system as defined above, additionally comprising means adaptedto toggle the surgical tools.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the toggling is performedmanually or automatically.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the image processing isobtained by at least one algorithm selected from the group consistingof: image stabilization algorithm, image improvement algorithm, imagecompilation algorithm, image enhancement algorithm, image detectionalgorithm, image classification algorithm, image correlation with thecardiac cycle or the respiratory cycle of the human body, smoke orvapor, steam reduction from the endoscope and any combination thereof.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the endoscope comprises animage acquisition device selected from the group consisting of: acamera, a video camera, an electromagnetic sensor, a computer tomographyimaging device, a fluoroscopic imaging device, an ultrasound imagingdevice, and any combination thereof.

It is another object of the present invention to provide the surgicaltracking system as defined above, further comprising a display adaptedto provide input or output to the operator regarding the operation ofthe system.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the display is used forvisualizing the region of interest by the operator.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the display is adapted tooutput the acquired real-time images of a surgical environment withaugmented reality elements.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the image processing algorithmis adapted to analyze 2D or 3D representation rendered from thereal-time images of the surgical environment.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the data processor is furtheradapted to operate a pattern recognition algorithm for assisting theoperation of the instructing functions g_(i)(t).

It is another object of the present invention to provide the surgicaltracking system as defined above, additionally comprising at least onelocation estimating means for locating the position of at least onesurgical tool in the surgical environment.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein the at least one locationestimating means are an interface subsystem between a surgeon and the atleast one surgical tool, the interface subsystem comprises:

-   -   a. at least one array comprising N regular or pattern light        sources, where N is a positive integer;    -   b. at least one array comprising M cameras, each of the M        cameras, where M is a positive integer;    -   c. optional optical markers and means for attaching the optical        marker to the at least one surgical tool; and,    -   d. a computerized algorithm operable via the controller, the        computerized algorithm adapted to record images received by each        camera of each of the M cameras and to calculate therefrom the        position of each of the tools, and further adapted to provide        automatically the results of the calculation to the human        operator of the interface.

It is another object of the present invention to provide a method forassisting an operator to perform a laparoscopic surgery of a human body,the method comprising steps of:

-   -   a. providing a surgical tracking system, comprising: (i) at        least one endoscope adapted to acquire real-time images of a        surgical environment within the human body; (ii) a maneuvering        subsystem in communication with the endoscope; and, (iii) a        tracking subsystem in communication with the maneuvering        subsystem, the tracking subsystem comprises a data processor;    -   b. performing real-time image processing of the surgical        environment;    -   c. controlling the maneuvering system via the tracking        subsystem, thereby directing and modifying the spatial position        of the endoscope to a region of interest according to input        received from a maneuvering function f(t);    -   wherein the maneuvering function f(t) is adapted to (a) receive        input from at least two instructing functions g_(i)(t), where i        is 1, . . . , n and n≧2; where t is time; i and n are integers;        and, to (b) output instructions to the maneuvering subsystem        based on the input from the at least two instructing functions        g_(i)(t), so as to spatially position the endoscope to the        region of interest.

It is another object of the present invention to provide the method asdefined above, wherein each of the instructing functions g_(i)(t) isprovided with α_(i)(t) where i is an integer greater than or equals to1; where α_(i)(t) are weighting functions of each g_(i)(t), and a n istotal number of instruction functions.

It is another object of the present invention to provide the method asdefined above, wherein each of the instructing functions g_(i)(t) isselected from a group consisting of: most used tool function, a righttool function, left tool function, field of view function, preferredvolume zone function, preferred tool function, no fly zone function, atool detection function, a movement detection function, an organdetection function, a collision detection function, an operator inputfunction, a prediction function, a past statistical analysis function,proximity function, a tagged tool function, and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the weighting functions α_(i)(t) are time-varyingfunctions, wherein the value of which is determined by the operators.

It is another object of the present invention to provide the method asdefined above, wherein the tool detection function is adapted to detectsurgical tools in the surgical environment and to output instructions tothe tracking subsystem to instruct the maneuvering system to direct theendoscope on the detected surgical tools.

It is another object of the present invention to provide the method asdefined above, wherein the movement detection function comprises acommunicable database comprising the real-time 3D spatial positions ofeach of the surgical tool in the surgical environment; and to detectmovement of the at least one surgical tool when a change in the 3Dspatial positions is received, and to output instructions to thetracking subsystem to instruct the maneuvering system to direct theendoscope on the moved surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the organ detection function is adapted to detectorgans in the surgical environment and to output instructions to thetracking subsystem to instruct the maneuvering system to direct theendoscope on the detected organs.

It is another object of the present invention to provide the method asdefined above, wherein the right tool function is adapted to detectsurgical tool positioned to right of the endoscope and to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to constantly direct the endoscope on the right tool and to trackthe right tool.

It is another object of the present invention to provide the method asdefined above, wherein the left tool function is adapted to detectsurgical tool positioned to left of the endoscope and to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to constantly direct the endoscope on the left tool and to trackthe left tool.

It is another object of the present invention to provide the method asdefined above, wherein the operator input function comprises acommunicable database; the communicable database is adapted to receivean input from the operator of the system; the input comprising n 3Dspatial positions; n is an integer greater than or equals to 2; and tooutput instructions to the tracking subsystem to instruct themaneuvering system to direct the endoscope to the at least one 3Dspatial position received.

It is another object of the present invention to provide the method asdefined above, wherein the proximity function is adapted to define apredetermined distance between at least two surgical tools; and tooutput instructions to the tracking subsystem to instruct themaneuvering system to direct the endoscope to the two surgical tools ifthe distance between the two surgical tools is less than thepredetermined distance.

It is another object of the present invention to provide the method asdefined above, wherein the proximity function is adapted to define apredetermined angle between at least three surgical tools; and to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to direct the endoscope to the three surgical tools if the anglebetween the two surgical tools is less than or greater than thepredetermined angle.

It is another object of the present invention to provide the method asdefined above, wherein the preferred volume zone function comprisescommunicable database comprising n 3D spatial positions; n is an integergreater than or equals to 2; the n 3D spatial positions provides thepreferred volume zone; the preferred volume zone function is adapted tooutput instructions to the tracking subsystem to instruct themaneuvering system to direct the endoscope to the preferred volume zone.

It is another object of the present invention to provide the method asdefined above, wherein the preferred tool function comprises acommunicable database, the database stores a preferred tool; thepreferred tool function is adapted to output instructions to thetracking subsystem to instruct the maneuvering system to direct theendoscope to the preferred tool.

It is another object of the present invention to provide the method asdefined above, wherein the collision prevention function is adapted todefine a predetermined distance between the at least one surgical tooland an anatomical element within the surgical environment; and to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to direct the endoscope to the surgical tool and the anatomicalelement within the surgical environment if the distance between the atleast one surgical tool and an anatomical element is less than thepredetermined distance.

It is another object of the present invention to provide the method asdefined above, wherein the anatomical element is selected from a groupconsisting of tissue, organ, another surgical tool or any combinationthereof.

It is another object of the present invention to provide the method asdefined above, wherein the field of view function comprises acommunicable database comprising n 3D spatial positions; n is an integergreater than or equals to 2; the combination of all of the n 3D spatialpositions provides a predetermined field of view; the field of viewfunction is adapted to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to at least one3D spatial position substantially within the n 3D spatial positions soas to maintain a constant field of view.

It is another object of the present invention to provide the method asdefined above, wherein the no fly zone function comprises a communicabledatabase comprising n 3D spatial positions; n is an integer greater thanor equals to 2; the n 3D spatial positions define a predetermined volumewithin the surgical environment; the no fly zone function is adapted tooutput instructions to the tracking subsystem to instruct themaneuvering system to direct the endoscope to at least one 3D spatialposition substantially different from all the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the most used tool function comprises acommunicable database counting the amount of movement of each surgicaltool located within the surgical environment; the most used toolfunction is adapted to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to constantlyposition the endoscope to track the movement of the most moved surgicaltool.

It is another object of the present invention to provide the method asdefined above, wherein the prediction function comprises a communicabledatabase storing each 3D spatial position of each of surgical toolwithin the surgical environment, such that each movement of eachsurgical tool is stored; the prediction function is adapted to (a) topredict the future 3D spatial position of each of the surgical tools;and, (b) to output instructions to the tracking subsystem to instructthe maneuvering system to direct the endoscope to the future 3D spatialposition.

It is another object of the present invention to provide the method asdefined above, wherein the past statistical analysis function comprisesa communicable database storing each 3D spatial position of each ofsurgical tool within the surgical environment, such that each movementof each surgical tool is stored; the past statistical analysis functionis adapted to (a) statistical analyze the 3D spatial positions of eachof the surgical tools; and, (b) to predict the future 3D spatialposition of each of the surgical tools; and, (c) to output instructionsto the tracking subsystem to instruct the maneuvering system to directthe endoscope to the future 3D spatial position.

It is another object of the present invention to provide the method asdefined above, wherein the a tagged tool function comprises meansadapted to tag at least one surgical tool within the surgicalenvironment and to output instructions to the tracking subsystem toinstruct the maneuvering system to constantly direct the endoscope tothe tagged surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the means are adapted to constantly tag the atleast one of surgical tool within the surgical environment.

It is another object of the present invention to provide the method asdefined above, wherein means are adapted to re-tag the at least one ofthe surgical tools until a desired tool is selected.

It is another object of the present invention to provide the method asdefined above, additionally comprising step of providing means adaptedto toggle the surgical tools.

It is another object of the present invention to provide the method asdefined above, wherein the toggling is performed manually orautomatically.

It is another object of the present invention to provide the method asdefined above, wherein the image processing is obtained by at least onealgorithm selected from the group consisting of: image stabilizationalgorithm, image improvement algorithm, image compilation algorithm,image enhancement algorithm, image detection algorithm, imageclassification algorithm, image correlation with the cardiac cycle orthe respiratory cycle of the human body, smoke or vapor, steam reductionfrom the endoscope and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the endoscope comprises an image acquisitiondevice selected from the group consisting of: a camera, a video camera,an electromagnetic sensor, a computer tomography imaging device, afluoroscopic imaging device, an ultrasound imaging device, and anycombination thereof.

It is another object of the present invention to provide the method asdefined above, further comprising step of providing a display adapted toprovide input or output to the operator regarding the operation of thesystem.

It is another object of the present invention to provide the method asdefined above, wherein the display is used for visualizing the region ofinterest by the operator.

It is another object of the present invention to provide the method asdefined above, wherein the display is adapted to output the acquiredreal-time images of a surgical environment with augmented realityelements.

It is another object of the present invention to provide the method asdefined above, wherein the image processing algorithm is adapted toanalyze 2D or 3D representation rendered from the real-time images ofthe surgical environment.

It is another object of the present invention to provide the method asdefined above, wherein the data processor is further adapted to operatea pattern recognition algorithm for assisting the operation of theinstructing functions g_(i)(t).

It is another object of the present invention to provide the method asdefined above, additionally comprising step of preliminary tagging atleast one of the surgical tools.

It is another object of the present invention to provide the method asdefined above, additionally comprising step of constantly tagging atleast one of the surgical tools.

It is another object of the present invention to provide the method asdefined above, additionally comprising step of re-tagging the at leastone of the surgical tools until a desired tool is selected.

It is another object of the present invention to provide the method asdefined above, additionally comprising step of toggling the surgicaltools.

It is another object of the present invention to provide the method asdefined above, wherein the toggling is performed manually orautomatically.

It is another object of the present invention to provide the method asdefined above, additionally comprising step of locating the 3D positionof at least one surgical tool in the surgical environment.

It is another object of the present invention to provide the method asdefined above, wherein the step of locating the 3D position of at leastone surgical tool is provided by at least one location estimating means;the at least one location estimating means are an interface subsystembetween a surgeon and the at least one surgical tool, the interfacesubsystem comprises:

-   -   a. at least one array comprising N regular or pattern light        sources, where N is a positive integer;    -   b. at least one array comprising M cameras, each of the M        cameras, where M is a positive integer;    -   c. optional optical markers and means for attaching the optical        marker to the at least one surgical tool; and,    -   d. a computerized algorithm operable via the controller, the        computerized algorithm adapted to record images received by each        camera of each of the M cameras and to calculate therefrom the        position of each of the tools, and further adapted to provide        automatically the results of the calculation to the human        operator of the interface.

It is another object of the present invention to provide a surgicalcontrolling system, comprising:

-   -   a. at least one endoscope adapted to provide real-time image of        surgical environment of a human body;    -   b. at least one processing means, adapted to real time define n        element within the real-time image of surgical environment of a        human body; each of the elements is characterized by        predetermined characteristics;    -   c. image processing means in communication with the endoscope,        adapted to image process the real-time image and to provide real        time updates of the predetermined characteristics;    -   d. a communicable database, in communication with the processing        means and the image processing means, adapted to store the        predetermined characteristics and the updated characteristics;    -   wherein the system is adapted to notify if the updated        characteristics are substantially different from the        predetermined characteristics.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the predeterminedcharacteristics are selected from a group consisting of color of theelement, 3D spatial location of the element, contours of the element,and any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, additionally comprising at leastone surgical tool adapted to be inserted into a surgical environment ofa human body for assisting a surgical procedure.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, additionally comprising (a) atleast one location estimating means adapted to real-time estimate thelocation of the at least one surgical tool at any given time t; and, (b)at least one movement detection means communicable with a movement'sdatabase and with said location estimating means; said movement'sdatabase is adapted to store said 3D spatial position of said at leastone surgical tool at time t_(f) and at time t₀; where t_(f)>t₀; saidmovement detection means is adapted to detect movement of said at leastone surgical tool if the 3D spatial position of said at least onesurgical tool at time t_(f) is different than said 3D spatial positionof said at least one surgical tool at time t₀.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, additionally comprising acontroller having a processing means communicable with a controller'sdatabase, the controller adapted to control the spatial position of theat least one surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the controller's databaseis adapted to store a predetermined set of rules according to whichALLOWED and RESTRICTED movements of the at least one surgical tool aredetermined, such that each detected movement by said movement detectionmeans of said at least one surgical tool is determined as either anALLOWED movement or as a RESTRICTED movement according to saidpredetermined set of rules.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the predetermined set ofrules comprises at least one rule selected from the group consisting of:most used tool rule, right tool rule, left tool rule, field of viewrule, no fly zone rule, route rule, environmental rule, operator inputrule, proximity rule; collision prevention rule, history based rule,tool-dependent allowed and RESTRICTED movements rule, preferred volumezone rule, preferred tool rule, movement detection rule, and anycombination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the route rule comprises acommunicable database storing predefined route in which the at least onesurgical tool is adapted to move within the surgical environment; thepredefined route comprises n 3D spatial positions of the at least onesurgical tool; n is an integer greater than or equals to 2; the ALLOWEDmovements are movements in which the at least one surgical tool islocated substantially in at least one of the n 3D spatial positions ofthe predefined route, and the RESTRICTED movements are movements inwhich the location of the at least one surgical tool is substantiallydifferent from the n 3D spatial positions of the predefined route.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the environmental rulecomprises a comprises a communicable database; the communicable databaseis adapted to received real-time image of the surgical environment andis adapted to perform real-time image processing of the same and todetermined the 3D spatial position of hazards or obstacles in thesurgical environment; the environmental rule is adapted to determine theALLOWED and RESTRICTED movements according to the hazards or obstaclesin the surgical environment, such that the RESTRICTED movements aremovements in which the at least one surgical tool is locatedsubstantially in at least one of the 3D spatial positions, and theALLOWED movements are movements in which the location of the at leastone surgical tool is substantially different from the 3D spatialpositions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the hazards or obstacles inthe surgical environment are selected from a group consisting of tissue,a surgical tool, an organ, an endoscope and any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the operator input rulecomprises a communicable database; the communicable database is adaptedto receive an input from the operator of the system regarding theALLOWED and RESTRICTED movements of the at least one surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the input comprises n 3Dspatial positions; n is an integer greater than or equals to 2; whereinat least one of which is defined as ALLOWED location and at least one ofwhich is defined as RESTRICTED location, such that the ALLOWED movementsare movements in which the at least one surgical tool is locatedsubstantially in at least one of the n 3D spatial positions, and theRESTRICTED movements are movements in which the location of the at leastone surgical tool is substantially different from the n 3D spatialpositions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the input comprises atleast one rule according to which ALLOWED and RESTRICTED movements ofthe at least one surgical tool are determined, such that the spatialposition of the at least one surgical tool is controlled by thecontroller according to the ALLOWED and RESTRICTED movements.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the predetermined set ofrules comprises at least one rule selected from the group consisting of:most used tool, right tool rule, left tool rule, field of view rule, nofly zone rule, a route rule, an environmental rule, an operator inputrule, a proximity rule; a collision prevention rule, preferred volumezone rule, movement detection rule, a history based rule, atool-dependent allowed and RESTRICTED movements rule, and anycombination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the operator input ruleconverts an ALLOWED movement to a RESTRICTED movement and a RESTRICTEDmovement to an ALLOWED movement.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the proximity rule isadapted to define a predetermined distance between at least two surgicaltools; the ALLOWED movements are movements which are within the range orout of the range of the predetermined distance, and the RESTRICTEDmovements which are out of the range or within the range of thepredetermined distance.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the proximity rule isadapted to define a predetermined angle between at least three surgicaltools; the ALLOWED movements are movements which are within the range orout of the range of the predetermined angle, and the RESTRICTEDmovements which are out of the range or within the range of thepredetermined angle.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the collision preventionrule is adapted to define a predetermined distance between the at leastone surgical tool and an anatomical element within the surgicalenvironment; the ALLOWED movements are movements which are in a rangethat is larger than the predetermined distance, and the RESTRICTEDmovements are movements which is in a range that is smaller than thepredetermined distance.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the anatomical element isselected from a group consisting of tissue, organ, another surgical toolor any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein at least one of thefollowing is being held true (a) said system additionally comprising anendoscope; said endoscope is adapted to provide real-time image of saidsurgical environment; (b) at least one of said surgical tools is anendoscope adapted to provide real-time image of said surgicalenvironment.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the right tool rule isadapted to determine the ALLOWED movement of the endoscope according tothe movement of the surgical tool positioned to right of the endoscope.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the left tool rule isadapted to determine the ALLOWED movement of the endoscope according tothe movement of the surgical tool positioned to left of the endo scope.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the field of view rulecomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equals to 2; the combination of all of then 3D spatial positions provides a predetermined field of view; the fieldof view rule is adapted to determine the ALLOWED movement of theendoscope within the n 3D spatial positions so as to maintain a constantfield of view, such that the ALLOWED movements are movements in whichthe endoscope is located substantially in at least one of the n 3Dspatial positions, and the RESTRICTED movements are movements in whichthe location of the endoscope is substantially different from the n 3Dspatial positions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the preferred volume zonerule comprises a communicable database comprising n 3D spatialpositions; n is an integer greater than or equals to 2; the n 3D spatialpositions provides the preferred volume zone; the preferred volume zonerule is adapted to determine the ALLOWED movement of the endoscopewithin the n 3D spatial positions and RESTRICTED movement of theendoscope outside the n 3D spatial positions, such that the ALLOWEDmovements are movements in which the endoscope is located substantiallyin at least one of the n 3D spatial positions, and the RESTRICTEDmovements are movements in which the location of the endoscope issubstantially different from the n 3D spatial positions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the preferred tool rulecomprises a communicable database, the database stores a preferred tool;the preferred tool rule is adapted to determine the ALLOWED movement ofthe endoscope according to the movement of the preferred tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the no fly zone rulecomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equals to 2; the n 3D spatial positionsdefine a predetermined volume within the surgical environment; the nofly zone rule is adapted to determine the RESTRICTED movement if themovement is within the no fly zone and the ALLOWED movement if themovement is outside the no fly zone, such that the RESTRICTED movementsare movements in which the at least one of the surgical tool is locatedsubstantially in at least one of the n 3D spatial positions, and theALLOWED movements are movements in which the location of the at leastone surgical tool is substantially different from the n 3D spatialpositions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the most used tool rulecomprises a communicable database counting the amount of movement ofeach of the surgical tools; the most used tool rule is adapted toconstantly position the endoscope to track the movement of the mostmoved surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein said system furthercomprising a maneuvering subsystem communicable with said controller,said maneuvering subsystem is adapted to spatially reposition said atleast one surgical tool during a surgery according to said predeterminedset of rules; further wherein the system is adapted to alert thephysician of a RESTRICTED movements of the at least one surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the alert is selected froma group consisting of audio signaling, voice signaling, light signaling,flashing signaling and any combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the ALLOWED movement ispermitted by the controller and a RESTRICTED movement is denied by thecontroller.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the history based rulecomprises a communicable database storing each 3D spatial position ofeach of the surgical tool, such that each movement of each surgical toolis stored; the history based rule is adapted to determine the ALLOWEDand RESTRICTED movements according to historical movements of the atleast one surgical tool, such that the ALLOWED movements are movementsin which the at least one surgical tool is located substantially in atleast one of the 3D spatial positions, and the RESTRICTED movements aremovements in which the location of the at least one surgical tool issubstantially different from the n 3D spatial positions.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the tool-dependent allowedand RESTRICTED movements rule comprises a communicable database; thecommunicable database is adapted to store predetermined characteristicsof at least one of the surgical tool; the tool-dependent allowed andRESTRICTED movements rule is adapted to determine the ALLOWED andRESTRICTED movements according to the predetermined characteristics ofthe surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the predeterminedcharacteristics of the surgical tool are selected from the groupconsisting of: physical dimensions, structure, weight, sharpness, andany combination thereof.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the movement detection rulecomprises a communicable database comprising the real-time 3D spatialpositions of each of the surgical tool; and to detect movement of the atleast one surgical tool when a change in the 3D spatial positions isreceived, such that the ALLOWED movements are movements in which theendoscope is directed to focus on the moving surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, further comprising a maneuveringsubsystem communicable with the controller, the maneuvering subsystem isadapted to spatially reposition at least one surgical tool during asurgery according to the predetermined set of rules, such that if saidmovement of said at least one surgical tool is a RESTRICTED movement,said maneuvering subsystem prevents said movement.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, further comprising at least onelocation estimating means adapted to acquire real-time images of thesurgical environment within the human body for the estimation of the 3Dspatial position of at least one surgical tool.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein the at least one locationestimating means are comprises at least one selected from a groupconsisting of optical imaging means, radio frequency transmitting andreceiving means, at least one mark on the at least one surgical tool andany combination thereof.

It is another object of the present invention to provide a method forcontrolling surgical surgery, comprising step of:

-   -   a. obtaining a system comprising:        -   i. at least one endoscope adapted to provide real-time image            of surgical environment of a human body;        -   ii. at least one processing means, adapted to real time            define n element within the real-time image of surgical            environment of a human body; each of the elements is            characterized by predetermined characteristics;        -   iii. image processing means in communication with the            endoscope, adapted to image process the real-time image and            to provide real time updates of the predetermined            characteristics;        -   iv. a communicable database, in communication with the            processing means and the image processing means, adapted to            store the predetermined characteristics and the updated            characteristics;    -   b. providing a real-time image of surgical environment of a        human body;    -   c. defining the n element;    -   d. characterizing each of the element with predetermined        characteristics;    -   e. providing a real-time update of the predetermined        characteristics;    -   f. notifying the user if the updated characteristics are        substantially different from the predetermined characteristics.

It is another object of the present invention to provide the method asdefined above, wherein the predetermined characteristics are selectedfrom a group consisting of color of the element, 3D spatial location ofthe element, contours of the element, and any combination thereof.

It is another object of the present invention to provide the method asdefined above, additionally comprising at least one surgical tooladapted to be inserted into a surgical environment of a human body forassisting a surgical procedure.

It is another object of the present invention to provide the method asdefined above, additionally comprising (a) at least one locationestimating means adapted to real-time estimate the location of the atleast one surgical tool at any given time t; and, (b) at least onemovement detection means communicable with a movement's database andwith said location estimating means; said movement's database is adaptedto store said 3D spatial position of said at least one surgical tool attime t_(f) and at time t₀; where t_(f)>t₀; said movement detection meansis adapted to detect movement of said at least one surgical tool if the3D spatial position of said at least one surgical tool at time t_(f) isdifferent than said 3D spatial position of said at least one surgicaltool at time t₀.

It is another object of the present invention to provide the method asdefined above, additionally comprising a controller having a processingmeans communicable with a controller's database, the controller adaptedto control the spatial position of the at least one surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the controller's database is adapted to store apredetermined set of rules according to which ALLOWED and RESTRICTEDmovements of the at least one surgical tool are determined, such thateach detected movement by said movement detection means of said at leastone surgical tool is determined as either an ALLOWED movement or as aRESTRICTED movement according to said predetermined set of rules.

It is another object of the present invention to provide the method asdefined above, wherein the predetermined set of rules comprises at leastone rule selected from the group consisting of: most used tool, righttool rule, left tool rule, field of view rule, no fly zone rule, a routerule, an environmental rule, an operator input rule, a proximity rule; acollision prevention rule, preferred volume zone rule, preferred toolrule, movement detection rule, a history based rule, a tool-dependentallowed and RESTRICTED movements rule, and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the route rule comprises a communicable databasestoring predefined route in which the at least one surgical tool isadapted to move within the surgical environment; the predefined routecomprises n 3D spatial positions of the at least one surgical tool; n isan integer greater than or equals to 2; the ALLOWED movements aremovements in which the at least one surgical tool is locatedsubstantially in at least one of the n 3D spatial positions of thepredefined route, and the RESTRICTED movements are movements in whichthe location of the at least one surgical tool is substantiallydifferent from the n 3D spatial positions of the predefined route.

It is another object of the present invention to provide the method asdefined above, wherein the environmental rule comprises a comprises acommunicable database; the communicable database is adapted to receivedreal-time image of the surgical environment and is adapted to performreal-time image processing of the same and to determined the 3D spatialposition of hazards or obstacles in the surgical environment; theenvironmental rule is adapted to determine the ALLOWED and RESTRICTEDmovements according to the hazards or obstacles in the surgicalenvironment, such that the RESTRICTED movements are movements in whichthe at least one surgical tool is located substantially in at least oneof the 3D spatial positions, and the ALLOWED movements are movements inwhich the location of the at least one surgical tool is substantiallydifferent from the 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the hazards or obstacles in the surgicalenvironment are selected from a group consisting of tissue, a surgicaltool, an organ, an endoscope and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the operator input rule comprises a communicabledatabase; the communicable database is adapted to receive an input fromthe operator of the system regarding the ALLOWED and RESTRICTEDmovements of the at least one surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the input comprises n 3D spatial positions; n isan integer greater than or equals to 2; wherein at least one of which isdefined as ALLOWED location and at least one of which is defined asRESTRICTED location, such that the ALLOWED movements are movements inwhich the at least one surgical tool is located substantially in atleast one of the n 3D spatial positions, and the RESTRICTED movementsare movements in which the location of the at least one surgical tool issubstantially different from the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the input comprises at least one predeterminedrule according to which ALLOWED and RESTRICTED movements of the at leastone surgical tool are determined, such that the spatial position of theat least one surgical tool is controlled by the controller according tothe ALLOWED and RESTRICTED movements.

It is another object of the present invention to provide the method asdefined above, wherein the predetermined rule is selected from the groupconsisting of: most used tool, right tool rule, left tool rule, field ofview rule, no fly zone rule, a route rule, an environmental rule, anoperator input rule, a proximity rule; a collision prevention rule,preferred volume zone rule, preferred tool rule, movement detectionrule, a history based rule, a tool-dependent allowed and RESTRICTEDmovements rule, and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the operator input rule converts an ALLOWEDmovement to a RESTRICTED movement and a RESTRICTED movement to anALLOWED movement.

It is another object of the present invention to provide the method asdefined above, wherein the proximity rule is adapted to define apredetermined distance between at least two surgical tools; the ALLOWEDmovements are movements which are within the range or out of the rangeof the predetermined distance, and the RESTRICTED movements which areout of the range or within the range of the predetermined distance.

It is another object of the present invention to provide the method asdefined above, wherein the proximity rule is adapted to define apredetermined angle between at least three surgical tools; the ALLOWEDmovements are movements which are within the range or out of the rangeof the predetermined angle, and the RESTRICTED movements which are outof the range or within the range of the predetermined angle.

It is another object of the present invention to provide the method asdefined above, wherein the collision prevention rule is adapted todefine a predetermined distance between the at least one surgical tooland an anatomical element within the surgical environment; the ALLOWEDmovements are movements which are in a range that is larger than thepredetermined distance, and the RESTRICTED movements are movements whichis in a range that is smaller than the predetermined distance.

It is another object of the present invention to provide the method asdefined above, wherein the anatomical element is selected from a groupconsisting of tissue, organ, another surgical tool or any combinationthereof.

It is another object of the present invention to provide the method asdefined above, wherein at least one of the following is being held true(a) said system additionally comprising an endoscope; said endoscope isadapted to provide real-time image of said surgical environment; (b) atleast one of said surgical tools is an endoscope adapted to providereal-time image of said surgical environment.

It is another object of the present invention to provide the method asdefined above, wherein the right tool rule is adapted to determine theALLOWED movement of the endoscope according to the movement of thesurgical tool positioned to right of the endoscope.

It is another object of the present invention to provide the method asdefined above, wherein the left tool rule is adapted to determine theALLOWED movement of the endoscope according to the movement of thesurgical tool positioned to left of the endoscope.

It is another object of the present invention to provide the method asdefined above, wherein the field of view rule comprises a communicabledatabase comprising n 3D spatial positions; n is an integer greater thanor equals to 2; the combination of all of the n 3D spatial positionsprovides a predetermined field of view; the field of view rule isadapted to determine the ALLOWED movement of the endoscope within the n3D spatial positions so as to maintain a constant field of view, suchthat the ALLOWED movements are movements in which the endoscope islocated substantially in at least one of the n 3D spatial positions, andthe RESTRICTED movements are movements in which the location of theendoscope is substantially different from the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the preferred volume zone rule comprises acommunicable database comprising n 3D spatial positions; n is an integergreater than or equals to 2; the n 3D spatial positions provides thepreferred volume zone; the preferred volume zone rule is adapted todetermine the ALLOWED movement of the endoscope within the n 3D spatialpositions and RESTRICTED movement of the endoscope outside the n 3Dspatial positions, such that the ALLOWED movements are movements inwhich the endoscope is located substantially in at least one of the n 3Dspatial positions, and the RESTRICTED movements are movements in whichthe location of the endoscope is substantially different from the n 3Dspatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the preferred tool rule comprises a communicabledatabase, the database stores a preferred tool; the preferred tool ruleis adapted to determine the ALLOWED movement of the endoscope accordingto the movement of the preferred tool.

It is another object of the present invention to provide the method asdefined above, wherein the no fly zone rule comprises a communicabledatabase comprising n 3D spatial positions; n is an integer greater thanor equals to 2; the n 3D spatial positions define a predetermined volumewithin the surgical environment; the no fly zone rule is adapted todetermine the RESTRICTED movement if the movement is within the no flyzone and the ALLOWED movement if the movement is outside the no flyzone, such that the RESTRICTED movements are movements in which the atleast one of the surgical tool is located substantially in at least oneof the n 3D spatial positions, and the ALLOWED movements are movementsin which the location of the at least one surgical tool is substantiallydifferent from the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the most used tool rule comprises a communicabledatabase counting the amount of movement of each of the surgical tools;the most used tool rule is adapted to constantly position the endoscopeto track the movement of the most moved surgical tool.

It is another object of the present invention to provide the method asdefined above, additionally comprising step of alerting the physician ofa RESTRICTED movement of the at least one surgical tool.

It is another object of the present invention to provide the method asdefined above, wherein the alert is selected from a group consisting ofaudio signaling, voice signaling, light signaling, flashing signalingand any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the ALLOWED movement is permitted by thecontroller and a RESTRICTED movement is denied by the controller.

It is another object of the present invention to provide the method asdefined above, wherein the history based rule comprises a communicabledatabase storing each 3D spatial position of each of the surgical tool,such that each movement of each surgical tool is stored; the historybased rule is adapted to determine the ALLOWED and RESTRICTED movementsaccording to historical movements of the at least one surgical tool,such that the ALLOWED movements are movements in which the at least onesurgical tool is located substantially in at least one of the 3D spatialpositions, and the RESTRICTED movements are movements in which thelocation of the at least one surgical tool is substantially differentfrom the n 3D spatial positions.

It is another object of the present invention to provide the method asdefined above, wherein the tool-dependent allowed and RESTRICTEDmovements rule comprises a communicable database; the communicabledatabase is adapted to store predetermined characteristics of at leastone of the surgical tool; the tool-dependent allowed and RESTRICTEDmovements rule is adapted to determine the ALLOWED and RESTRICTEDmovements according to the predetermined characteristics of the surgicaltool.

It is another object of the present invention to provide the method asdefined above, wherein the predetermined characteristics of the surgicaltool are selected from the group consisting of: physical dimensions,structure, weight, sharpness, and any combination thereof.

It is another object of the present invention to provide the method asdefined above, wherein the movement detection rule comprises acommunicable database comprising the real-time 3D spatial positions ofeach of the surgical tool; and to detect movement of the at least onesurgical tool when a change in the 3D spatial positions is received,such that the ALLOWED movements are movements in which the endoscope isdirected to focus on the moving surgical tool.

It is another object of the present invention to provide the method asdefined above, further comprising step of proving a maneuveringsubsystem communicable with the controller, the maneuvering subsystem isadapted to spatially reposition the at least one surgical tool during asurgery according to the predetermined set of rules.

It is another object of the present invention to provide a surgicalcontrolling system, comprising:

-   -   (a) at least one surgical tool adapted to be inserted into a        surgical environment of a human body for assisting a surgical        procedure;    -   (b) at least one endoscope adapted to provide real-time image of        said surgical environment;    -   (c) at least one location estimating means adapted to real-time        locate the 3D spatial position of said at least one surgical        tool at any given time t;    -   (d) at least one movement detection means communicable with a        movement's database and with said location estimating means;        said movement's database is adapted to store said 3D spatial        position of said at least one surgical tool at time t_(f) and at        time t₀; where t_(f)>t₀; said movement detection means is        adapted to detect movement of said at least one surgical tool if        the 3D spatial position of said at least one surgical tool at        time t_(f) is different than said 3D spatial position of said at        least one surgical tool at time t₀; and,    -   (e) a controller having a processing means communicable with a        controller's database, said controller adapted to control the        spatial position of said at least one surgical tool; said        controller's database is in communication with said movement        detection means;

wherein said controller's database comprising n 3D spatial positions; nis an integer greater than or equal to 2; the combination of all of saidn 3D spatial positions provides a predetermined field of view; saidcontroller is adapted to relocate the 3D spatial positions of saidendoscope if movement has been detected by said detection means, suchthat said field of view is maintained.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein controller's databasecomprises n 3D spatial positions; n is an integer greater than or equalto 2; the combination of all of said n 3D spatial positions provides apredetermined field of view; said field of view rule is adapted torelocate said endoscope if movement of at least one of said surgicaltools has been detected by said detection means, such that said field ofview is maintained.

It is another object of the present invention to provide the method asdefined above, wherein controller's database comprises n 3D spatialpositions; n is an integer greater than or equal to 2; the combinationof all of said n 3D spatial positions provides a predetermined field ofview; said field of view rule is adapted to relocate said endoscope ifmovement of at least one of said surgical tools has been detected bysaid detection means, such that said field of view is maintained.

It is another object of the present invention to provide the surgicaltracking system as defined above, wherein controller's databasecomprises n 3D spatial positions; n is an integer greater than or equalto 2; the combination of all of said n 3D spatial positions provides apredetermined field of view; said field of view rule is adapted torelocate said endoscope if movement of at least one of said surgicaltools has been detected by said detection means, such that said field ofview is maintained.

It is another object of the present invention to provide the method asdefined above, wherein controller's database comprises n 3D spatialpositions; n is an integer greater than or equal to 2; the combinationof all of said n 3D spatial positions provides a predetermined field ofview; said field of view rule is adapted to relocate said endoscope ifmovement of at least one of said surgical tools has been detected bysaid detection means, such that said field of view is maintained.

It is another object of the present invention to provide the surgicalcontrolling system as defined above, wherein controller's databasecomprises n 3D spatial positions; n is an integer greater than or equalto 2; the combination of all of said n 3D spatial positions provides apredetermined field of view; said field of view rule is adapted torelocate said endoscope if movement of at least one of said surgicaltools has been detected by said detection means, such that said field ofview is maintained.

It is another object of the present invention to provide the method asdefined above, wherein controller's database comprises n 3D spatialpositions; n is an integer greater than or equal to 2; the combinationof all of said n 3D spatial positions provides a predetermined field ofview; said field of view rule is adapted to relocate said endoscope ifmovement of at least one of said surgical tools has been detected bysaid detection means, such that said field of view is maintained.

BRIEF DESCRIPTION OF THE FIGURES

In order to understand the invention and to see how it may beimplemented in practice, and by way of non-limiting example only, withreference to the accompanying drawing, in which

FIG. 1A-B illustrates one embodiment of the present invention.

FIG. 2A shows an example of using the location system in abdominallaparoscopic surgery;

FIG. 2B shows an example of using the location system in knee endoscopicsurgery; and,

FIG. 2C shows an example of using the location system in shoulderendoscopic surgery.

FIG. 3A-D schematically illustrates operation of an embodiment of atracking system with collision avoidance system.

FIG. 4A-D schematically illustrates operation of an embodiment of atracking system with no fly zone rule/function.

FIG. 5A-D schematically illustrates operation of an embodiment of atracking system with preferred volume zone rule/function.

FIG. 6 schematically illustrates operation of an embodiment of the organdetection function/rule.

FIG. 7 schematically illustrates operation of an embodiment of the tooldetection function/rule.

FIG. 8A-B schematically illustrates operation of an embodiment of themovement detection function/rule.

FIG. 9A-D schematically illustrates operation of an embodiment of theprediction function/rule.

FIG. 10 schematically illustrates operation of an embodiment of theright tool function/rule.

FIG. 11A-B schematically illustrates operation of an embodiment of thefield of view function/rule.

FIG. 12 schematically illustrates operation of an embodiment of thetagged tool function/rule.

FIG. 13A-C schematically illustrates operation of an embodiment of theproximity function/rule.

FIG. 14A-B schematically illustrates operation of an embodiment of theoperator input function/rule.

FIGS. 15A-D schematically illustrate an embodiment of a tracking systemwith a constant field of view rule/function

FIG. 16 schematically illustrates an embodiment of a tracking systemwith a change of speed rule/function

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not limited in its applicationto the details of construction and the arrangement of the components setforth in the following description or illustrated in the drawings. Theinvention is applicable to other embodiments or of being practiced orcarried out in various ways. Also, it is to be understood that thephraseology and terminology employed herein is for the purpose ofdescription and should not be regarded as limiting.

The term ‘toggle’ refers hereinafter to switching between one taggedsurgical tool to another.

The term ‘surgical environment’ refers hereinafter to any anatomicalpart within the human body which may be in surrounding a surgicalinstrument. The environment may comprise: organs, body parts, walls oforgans, arteries, veins, nerves, a region of interest, or any otheranatomical part of the human body.

The term ‘endoscope’ refers hereinafter to any means adapted for lookinginside the body for medical reasons. This may be any instrument used toexamine the interior of a hollow organ or cavity of the body. Theendoscope may also refer to any kind of a laparascope. It should bepointed that the following description may refer to an endoscope as asurgical tool.

The term ‘region of interest’ refers hereinafter to any region withinthe human body which may be of interest to the operator of the system ofthe present invention. The region of interest may be, for example, anorgan to be operated on, a RESTRICTED area to which approach of asurgical instrument is RESTRICTED, a surgical instrument, or any otherregion within the human body.

The term ‘spatial position’ refers hereinafter to a predeterminedspatial location and/or orientation of an object (e.g., the spatiallocation of the endoscope, the angular orientation of the endoscope, andany combination thereof).

The term ‘prohibited area’ refers hereinafter to a predetermined area towhich a surgical tool (e.g., an endoscope) is prohibited to be spatiallypositioned in.

The term ‘preferred area’ refers hereinafter to predetermined area towhich a surgical tool (e.g., an endoscope) is allowed and/or preferredto be spatially positioned in.

The term ‘automated assistant’ refers hereinafter to any mechanicaldevice (including but not limited to a robotic device) that can maneuverand control the position of a surgical or endoscopic instrument, andthat can in addition be adapted to receive commands from a remotesource.

The term ‘tool’ or ‘surgical instrument’ refers hereinafter to anyinstrument or device introducible into the human body. The term mayrefer to any location on the tool. For example it can refer to the tipof the same, the body of the same and any combination thereof. It shouldbe further pointed that the following description may refer to asurgical tool/instrument as an endoscope.

The term ‘provide’ refers hereinafter to any process (visual, tactile,or auditory) by which an instrument, computer, controller, or any othermechanical or electronic device can report the results of a calculationor other operation to a human operator.

The term ‘automatic’ or ‘automatically’ refers to any process thatproceeds without the necessity of direct intervention or action on thepart of a human being.

The term ‘ALLOWED movement’ refers hereinafter to any movement of asurgical tool which is permitted according to a predetermined set ofrules.

The term ‘RESTRICTED movement’ refers hereinafter to any movement of asurgical tool which is forbidden according to a predetermined set ofrules. For example, one rule, according to the present invention,provides a preferred volume zone rule which defines a favored zonewithin the surgical environment. Thus, according to the presentinvention an allowed movement of a surgical tool or the endoscope is amovement which maintains the surgical tool within the favored zone; anda RESTRICTED movement of a surgical tool is a movement which extracts(or moves) the surgical tool outside the favored zone.

The term ‘time step’ refers hereinafter to the working time of thesystem. At each time step, the system receives data from sensors andcommands from operators and processes the data and commands and executesactions. The time step size is the elapsed time between time steps.

Laparoscopic surgery, also called minimally invasive surgery (MIS), is amodern surgical technique in which operations in the abdomen areperformed through small incisions (usually 0.5-1.5 cm) as compared tolarger incisions needed in traditional surgical procedures. The keyelement in laparoscopic surgery is the use of a laparoscope, which is adevice adapted for viewing the scene within the body, at the distal endof the laparoscope. Either an imaging device is placed at the end of thelaparoscope, or a rod lens system or fiber optic bundle is used todirect this image to the proximal end of the laparoscope. Also attachedis a light source to illuminate the operative field, inserted through a5 mm or 10 mm cannula or trocar to view the operative field.

The abdomen is usually injected with carbon dioxide gas to create aworking and viewing space. The abdomen is essentially blown up like aballoon (insufflated), elevating the abdominal wall above the internalorgans like a dome. Within this space, various medical procedures can becarried out.

In many cases, the laparoscope cannot view the entire working spacewithin the body, so the laparoscope is repositioned to allow the surgeonto view regions of interest within the space.

The present invention discloses a surgical controlling system adapted tocontrol the position of at least one surgical tool during a surgery ofthe human body. The system may perform the control by identifying thelocation of the surgical tool, and provide instruction to the operatorto which direction the surgical tool may or should be directed, and towhich direction the surgical tool is RESTRICTED from being moved to.

According to different embodiments of the present invention, thesurgical controlling system comprises the following components:

-   -   a. at least one surgical tool adapted to be inserted into a        surgical environment of a human body for assisting a surgical        procedure;    -   b. at least one location estimating means adapted to real-time        estimate/locate the location (i.e., the 3D spatial position) of        the at least one surgical tool at any given time t;    -   c. at least one movement detection means communicable with a        movement-database and with said location estimating means; said        movement-database is adapted to store said 3D spatial position        of said at least one surgical tool at time t_(f) and at time t₀;        where t_(f)>t₀; said movement detection means is adapted to        detect movement of said at least one surgical tool if the 3D        spatial position of said at least one surgical tool at time        t_(f) is different than said 3D spatial position of said at        least one surgical tool at time t₀; and,    -   d. a controller having a processing means communicable with a        database, the controller adapted to control the spatial position        of the at least one surgical tool;

It is within the scope of the present invention that the database isadapted to store a predetermined set of rules according to which ALLOWEDand RESTRICTED movements of the at least one surgical tool aredetermined, such that the spatial position of the at least one surgicaltool is controlled by the controller according to the ALLOWED andRESTRICTED movements. In other words, each detected movement by saidmovement detection means of said at least one surgical tool isdetermined as either an ALLOWED movement or as a RESTRICTED movementaccording to said predetermined set of rules.

Thus, the present invention stores the 3D spatial position of each ofsaid surgical tools at a current at time t_(f) and at time t₀; wheret_(f)>t₀. If the 3D spatial position of said at least one surgical toolat time t_(f) is different than said 3D spatial position of said atleast one surgical tool at time t₀ movement of the tool is detected.Next the system analyses said movement according to said set of rule andprocess whether said movement is ALLOWED movement or RESTRICTEDmovement.

According to one embodiment of the present invention, the systemprevents said movement, if said movement is a RESTRICTED movement. Saidmovement prevention is obtained by controlling a maneuvering systemwhich prevents the movement of said surgical tool.

According to one embodiment of the present invention, the system doesnot prevent said movement, (if said movement is a RESTRICTED movement),but merely signals/alerts the user (i.e., the physician) of saidRESTRICTED movement.

According to another embodiment of the present invention, said surgicaltool is an endoscope.

According to different embodiments of the present invention, thecontroller may provide a suggestion to the operator as to whichdirection the surgical tool has to move to or may be moved to.

Thus, according to a preferred embodiment of the present invention, thepresent invention provides a predetermined set of rules which definewhat is an “allowed movement” of any surgical tool within the surgicalenvironment and what is a “RESTRICTED movement” of any surgical toolwithin the surgical environment.

According to some embodiments the system of the present inventioncomprises a maneuvering subsystem communicable with the controller, themaneuvering subsystem is adapted to spatially reposition the at leastone surgical tool during surgery according to the predetermined set ofrules.

According to some embodiments, the controller may provide instructionsto a maneuvering subsystem for spatially repositioning the location ofthe surgical tool. According to these instructions, only ALLOWEDmovements of the surgical tool will be performed. Preventing RESTRICTEDmovements is performed by: detecting the location of the surgical tool;processing all current rules; analyzing the movement of the surgicaltool and preventing the movement if the tool's movement is a RESTRICTEDmovement.

According to some embodiments, system merely alerts the physician of aRESTRICTED movement of at least one surgical tool (instead of preventingsaid RESTRICTED movement).

Alerting the physician of RESTRICTED movements (or, alternativelypreventing a RESTRICTED movement) is performed by: detecting thelocation of the surgical tool; processing all current rules; analyzingthe movement of the surgical tool and informing the surgeon (the user ofthe system) if the tool's movement is an allowed movement or aRESTRICTED movement.

Thus, according to a preferred embodiment of the present invention, ifRESTRICTED movements are prevented, the same process (of detecting thelocation of the surgical tool; processing all current rules andanalyzing the movement of the surgical tool) is followed except for thelast movement, where the movement is prevented if the tool's movement isa RESTRICTED movement. The surgeon can also be informed that themovement is being prevented.

According to another embodiment, the above (alerting the physicianand/or preventing the movement) is performed by detecting the locationof the surgical tool and analyzing the surgical environment of thesurgical tool. Following analysis of the surgical environment anddetection of the location of the surgical tool, the system may assessall the risks which may follow a movement of the surgical tool in thepredetermined direction. Therefore, each location in the surgicalenvironment has to be analyzed so that any possible movement of thesurgical tool will be classified as an ALLOWED movement or a RESTRICTEDmovement.

According to one embodiment of the present invention, the location ofeach tool is determined using image processing means and determining inreal-time what is the 3D spatial location of each tool. It should beunderstood that the above mentioned “tool” may refer to the any locationon the tool. For example, it can refer to the tip of the same, the bodyof the same and any combination thereof.

The predetermined set of rules which are the essence of the presentinvention are adapted to take into consideration all the possiblefactors which may be important during the surgical procedure. Thepredetermined set of rules may comprise the following rules or anycombination thereof:

-   -   a. a route rule;    -   b. an environment rule;    -   c. an operator input rule;    -   d. a proximity rule;    -   e. a collision prevention rule;    -   f. a history based rule;    -   g. a tool-dependent allowed and RESTRICTED movements rule.    -   h. a most used tool rule;    -   i. a right tool rule;    -   j. a left tool rule;    -   k. a field of view rule;    -   l. a no fly zone rule;    -   m. an operator input rule;    -   n. a preferred volume zone rule;    -   o. a preferred tool rule;    -   p. a movement detection rule,

Thus, for example, the collision prevention rule defines a minimumdistance below which two or more tools should not be brought together(i.e., there is minimum distance between two or more tools that shouldbe maintained). If the movement of one tool will cause it to comedangerously close to another tool (i.e., the distance between them,after the movement, is smaller than the minimum distance defined by thecollision prevention rule), the controller either alerts the user thatthe movement is a RESTRICTED movement or does not permit the movement.

It should be emphasized that all of the above (and the followingdisclosure) is enabled by constantly monitoring the surgicalenvironment, and identifying and locating the 3D spatial location ofeach element/tool in the surgical environment.

The identification is provided by conventional means known to anyskilled in the art (e.g., image processing, optical means etc.).

The following provides explanations for each of the above mentionedrules and its functions:

According to some embodiments, the route rule comprises a predefinedroute in which the at least one surgical tool is adapted to move withinthe surgical environment; the ALLOWED movements are movements in whichthe at least one surgical tool is located within the borders of thepredefined route, and the RESTRICTED movements are movements in whichthe at least one surgical tool is located out of the borders of thepredefined route. Thus, according to this embodiment, the route rulecomprises a communicable database storing at least one predefined routein which the at least one surgical tool is adapted to move within thesurgical environment; the predefined route comprises n 3D spatialpositions of the at least one surgical tool in the route; n is aninteger greater than or equal to 2; ALLOWED movements are movements inwhich the at least one surgical tool is located substantially in atleast one of the n 3D spatial positions of the predefined route, andRESTRICTED movements are movements in which the location of the at leastone surgical tool is substantially different from the n 3D spatialpositions of the predefined route.

In other words, according to the route rule, each of the surgical tool'scourses (and path in any surgical procedure) is stored in a communicabledatabase. ALLOWED movements are defined as movements in which the atleast one surgical tool is located substantially in at least one of thestored routes; and RESTRICTED movements are movements in which the atleast one surgical tool is in a substantially different location thanany location in any stored route.

According to some embodiments, the environmental rule is adapted todetermine ALLOWED and RESTRICTED movements according to hazards orobstacles in the surgical environment as received from an endoscope orother sensing means. Thus, according to this embodiment, theenvironmental rule comprises a comprises a communicable database; thecommunicable database is adapted to received real-time images of thesurgical environment and is adapted to perform real-time imageprocessing of the same and to determine the 3D spatial position ofhazards or obstacles in the surgical environment; the environmental ruleis adapted to determine ALLOWED and RESTRICTED movements according tohazards or obstacles in the surgical environment, such that RESTRICTEDmovements are movements in which at least one surgical tool is locatedsubstantially in at least one of the 3D spatial positions, and ALLOWEDmovements are movements in which the location of at least one surgicaltool is substantially different from the 3D spatial positions.

In other words, according to the environment rule, each element in thesurgical environment is identified so as to establish which is a hazardor obstacle (and a path in any surgical procedure) and each hazard andobstacle (and path) is stored in a communicable database. RESTRICTEDmovements are defined as movements in which the at least one surgicaltool is located substantially in the same location as that of thehazards or obstacles; and the ALLOWED movements are movements in whichthe location of the at least one surgical tool is substantiallydifferent from that of all of the hazards or obstacles.

According to other embodiments, hazards and obstacles in the surgicalenvironment are selected from a group consisting of tissues, surgicaltools, organs, endoscopes and any combination thereof.

According to some embodiments, the operator input rule is adapted toreceive an input from the operator of the system regarding the ALLOWEDand RESTRICTED movements of the at least one surgical tool. Thus,according to this embodiment, the operator input rule comprises acommunicable database; the communicable database is adapted to receivean input from the operator of the system regarding ALLOWED andRESTRICTED movements of the at least one surgical tool.

According to other embodiments, the input comprises n 3D spatialpositions; n is an integer greater than or equal to 2; wherein at leastone of which is defined as an ALLOWED location and at least one of whichis defined as a RESTRICTED location, such that the ALLOWED movements aremovements in which the at least one surgical tool is locatedsubstantially in at least one of the n 3D ALLOWED spatial positions, andthe RESTRICTED movements are movements in which the location of the atleast one surgical tool is substantially different from the n 3D ALLOWEDspatial positions.

According to other embodiments, the input comprises at least one ruleaccording to which ALLOWED and RESTRICTED movements of the at least onesurgical tool are determined, such that the spatial position of the atleast one surgical tool is controlled by the controller according to theALLOWED and RESTRICTED movements.

According to other embodiments, the operator input rule can convert anALLOWED movement to a RESTRICTED movement and a RESTRICTED movement toan ALLOWED movement.

According to some embodiments, the proximity rule is adapted to define apredetermined distance between the at least one surgical tool and atleast one another surgical tool; the ALLOWED movements are movementswhich are within the range or out of the range of the predetermineddistance, and the RESTRICTED movements which are out of the range orwithin the range of the predetermined distance; the ALLOWED movementsand the RESTRICTED movements are defined according to different ranges.Thus, according to this embodiment, the proximity rule is adapted todefine a predetermined distance between at least two surgical tools. Ina preferred embodiment, the ALLOWED movements are movements which arewithin the range of the predetermined distance, while the RESTRICTEDmovements which are out of the range of the predetermined distance. Inanother preferred embodiment, the ALLOWED movements are movements whichare out of the range of the predetermined distance, while the RESTRICTEDmovements are within the range of the predetermined distance

It should be pointed out that the above mentioned distance can beselected from the following:

-   -   (f) the distance between the tip of the first tool and the tip        of the second tool;    -   (g) the distance between the body of the first tool and the tip        of the second tool;    -   (h) the distance between the body of the first tool and the body        of the second tool;    -   (i) the distance between the tip of the first tool and the body        of the second tool; and any combination thereof.

According to another embodiment, the proximity rule is adapted to definea predetermined angle between at least three surgical tools; ALLOWEDmovements are movements which are within the range or out of the rangeof the predetermined angle, and RESTRICTED movements are movements whichare out of the range or within the range of the predetermined angle.

According to some embodiments, the collision prevention rule is adaptedto define a predetermined distance between the at least one surgicaltool and an anatomical element within the surgical environment (e.g.tissue, organ, another surgical tool or any combination thereof); theALLOWED movements are movements which are in a range that is larger thanthe predetermined distance, and the RESTRICTED movements are movementswhich is in a range that is smaller than the predetermined distance.

According to another embodiment, the anatomical element is selected froma group consisting of tissue, organ, another surgical tool or anycombination thereof.

According to some embodiments, the surgical tool is an endoscope. Theendoscope is adapted to provide real-time images of the surgicalenvironment.

According to some embodiments, the right tool rule is adapted todetermine the ALLOWED movement of the endoscope according to themovement of a surgical tool in a specified position in relation to theendoscope, preferably positioned to right of the same. According to thisrule, the tool which is defined as the right tool is constantly trackedby the endoscope. According to some embodiments, the right tool isdefined as the tool positioned to the right of the endoscope; accordingto other embodiments, any tool can be defined as the right tool. Anallowed movement, according to the right tool rule, is a movement inwhich the endoscope field of view is moved to a location substantiallythe same as the location of the right tool, thereby tracking the righttool. A RESTRICTED movement, according to the right tool rule, is amovement in which the endoscope field of view is moved to a locationsubstantially different from the location of the right tool.

According to some embodiments, the left tool rule is adapted todetermine the ALLOWED movement of the endoscope according to themovement of a surgical tool in a specified position in relation to theendoscope, preferably positioned to left of the same. According to thisrule, the tool which is defined as the left tool is constantly trackedby the endoscope. According to some embodiments, the left tool isdefined as the tool positioned to the left of the endoscope; accordingto other embodiments, any tool can be defined as the left tool. Anallowed movement, according to the left tool rule, is a movement inwhich the endoscope field of view is moved to a location substantiallythe same as the location of the left tool. A RESTRICTED movement,according to the left tool rule, is a movement in which the endoscopefield of view is moved to a location substantially different from thelocation of the left tool.

According to some embodiments, the field of view rule is adapted todefine a field of view and maintain that field of view. The field ofview rule is defined such that if the endoscope is adapted to track apredetermined set of tools in a desired field of view, when one of thosetools is no longer in the field of view, the rule instructs theendoscope to zoom out so as to reintroduce the tool into the field ofview. Thus, according to this embodiment, the field of view rulecomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equal to 2; the combination of all of then 3D spatial positions provides a predetermined field of view; the fieldof view rule is adapted to determine the ALLOWED movement of theendoscope within the n 3D spatial positions so as to maintain a constantfield of view, such that the ALLOWED movements are movements in whichthe endoscope is located substantially in at least one of the n 3Dspatial positions, and the RESTRICTED movements are movements in whichthe location of the endoscope is substantially different from the n 3Dspatial positions.

Thus, according to another embodiment of the field of view rule, thefield of view rule comprises a communicable database comprising n 3Dspatial positions; n is an integer greater than or equal to 2; thecombination of all of the n 3D spatial positions provides apredetermined field of view. The field of view rule further comprises acommunicable database of m tools and the 3D spacial locations of thesame, where m is an integer greater than or equal to 1 and where a toolcan be a surgical tool, an anatomical element and any combinationthereof. The combination of all of the n 3D spatial positions provides apredetermined field of view. The field of view rule is adapted todetermine ALLOWED movement of the endoscope such that the m 3D spatialpositions of the tools comprise at least one of the n 3D spatialpositions of the field of view, and RESTRICTED movements are movementsin which the 3D spatial position of at least one tool is substantiallydifferent from the n 3D spatial positions of the field of view.

According to another embodiment, the preferred volume zone rulecomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equal to 2; the n 3D spatial positionsprovides the preferred volume zone; the preferred volume zone rule isadapted to determine the ALLOWED movement of the endoscope within the n3D spatial positions and RESTRICTED movement of the endoscope outsidethe n 3D spatial positions, such that the ALLOWED movements aremovements in which the endoscope is located substantially in at leastone of the n 3D spatial positions, and the RESTRICTED movements aremovements in which the location of the endoscope is substantiallydifferent from the n 3D spatial positions. In other words, the preferredvolume zone rule defines a volume of interest (a desired volume ofinterest), such that an ALLOWED movement, according to the preferredvolume zone rule, is a movement in which the endoscope (or any surgicaltool) is moved to a location within the defined preferred volume. ARESTRICTED movement, according to the preferred volume zone rule, is amovement in which the endoscope (or any surgical tool) is moved to alocation outside the defined preferred volume.

According to another embodiment, the preferred tool rule comprises acommunicable database, the database stores a preferred tool; thepreferred tool rule is adapted to determine the ALLOWED movement of theendoscope according to the movement of the preferred tool. In otherwords, the preferred tool rule defines a preferred tool (i.e., a tool ofinterest) that the user of the system wishes to track. An allowedmovement, according to the preferred tool rule, is a movement in whichthe endoscope is moved to a location substantially the same as thelocation of the preferred tool. A RESTRICTED movement is a movement inwhich the endo scope is moved to a location substantially different fromthe location of the preferred tool. Thus, according to the preferredtool rule the endoscope constantly tracks the preferred tool, such thatthe field of view, as seen from the endoscope, is constantly thepreferred tool. It should be noted that the user may define in saidpreferred tool rule to constantly tack the tip of said preferred tool oralternatively, the user may define in said preferred tool rule toconstantly track the body or any location on the preferred tool.

According to some embodiments, the no fly zone rule is adapted to definea RESTRICTED zone into which no tool (or alternatively no predefinedtool) is permitted to enter. Thus, according to this embodiment, the nofly zone rule comprises a communicable database comprising n 3D spatialpositions; n is an integer greater than or equal to 2; the n 3D spatialpositions define a predetermined volume within the surgical environment;the no fly zone rule is adapted to determine a RESTRICTED movement ifthe movement is within the no fly zone and an ALLOWED movement if themovement is outside the no fly zone, such that RESTRICTED movements aremovements in which the at least one surgical tool is locatedsubstantially in at least one of the n 3D spatial positions, and theALLOWED movements are movements in which the location of the at leastone surgical tool is substantially different from the n 3D spatialpositions.

According to another embodiment, the most used tool function is adaptedto define (either real-time, during the procedure or prior to theprocedure) which tool is the most used tool (i.e., the tool which ismoved the most during the procedure) and to instruct the maneuveringsubsystem to constantly position the endoscope to track the movement ofthis tool. Thus, according to this embodiment, the most used tool rulecomprises a communicable database counting the number of movements ofeach of the surgical tools; the most used tool rule is adapted toconstantly position the endoscope to track the movement of the surgicaltool with the largest number of movements. In another embodiment of themost used tool function, the communicable database measures the amountof movement of each of the surgical tools; the most used tool rule isadapted to constantly position the endoscope to track the movement ofthe surgical tool with the largest amount of movement.

According to another embodiment, the system is adapted to alert thephysician of a RESTRICTED movement of at least one surgical tool. Thealert can be audio signaling, voice signaling, light signaling, flashingsignaling and any combination thereof.

According to another embodiment, an ALLOWED movement is one permitted bythe controller and a RESTRICTED movement is one denied by thecontroller.

According to another embodiment, the operator input rule function isadapted to receive an input from the operator of the system regardingALLOWED and RESTRICTED movements of the at least one surgical tool. Inother words, the operator input rule function receives instructions fromthe physician as to what can be regarded as ALLOWED movements and whatare RESTRICTED movements. According to another embodiment, the operatorinput rule is adapted to convert an ALLOWED movement to a RESTRICTEDmovement and a RESTRICTED movement to an ALLOWED movement.

According to some embodiments, the history-based rule is adapted todetermine the ALLOWED and RESTRICTED movements according to historicalmovements of the at least one surgical tool in at least one previoussurgery. Thus, according to this embodiment, the history-based rulecomprises a communicable database storing each 3D spatial position ofeach of the surgical tools, such that each movement of each surgicaltool is stored; the history-based rule is adapted to determine ALLOWEDand RESTRICTED movements according to historical movements of the atleast one surgical tool, such that the ALLOWED movements are movementsin which the at least one surgical tool is located substantially in atleast one of the 3D spatial positions, and the RESTRICTED movements aremovements in which the location of the at least one surgical tool issubstantially different from the n 3D spatial positions.

According to some embodiments, the tool-dependent allowed and RESTRICTEDmovements rule is adapted to determine ALLOWED and RESTRICTED movementsaccording to predetermined characteristics of the surgical tool, wherethe predetermined characteristics of the surgical tool are selected froma group consisting of: physical dimensions, structure, weight,sharpness, and any combination thereof. Thus, according to thisembodiment, the tool-dependent ALLOWED and RESTRICTED movements rulecomprises a communicable database; the communicable database is adaptedto store predetermined characteristics of at least one of the surgicaltools; the tool-dependent ALLOWED and RESTRICTED movements rule isadapted to determine ALLOWED and RESTRICTED movements according to thepredetermined characteristics of the surgical tool.

According to another embodiment, the predetermined characteristics ofthe surgical tool are selected from a group consisting of: physicaldimensions, structure, weight, sharpness, and any combination thereof.

According to this embodiment, the user can define, e.g., the structureof the surgical tool he wishes the endoscope to track. Thus, accordingto the tool-dependent allowed and RESTRICTED movements rule theendoscope constantly tracks the surgical tool having said predeterminedcharacteristics as defined by the user.

According to another embodiment of the present invention, the movementdetection rule comprises a communicable database comprising thereal-time 3D spatial positions of each surgical tool; said movementdetection rule is adapted to detect movement of at least one surgicaltool. When a change in the 3D spatial position of that surgical tool isreceived, ALLOWED movements are movements in which the endoscope isre-directed to focus on the moving surgical tool.

According to another embodiment of the present invention, the systemfurther comprises a maneuvering subsystem communicable with thecontroller. The maneuvering subsystem is adapted to spatially repositionthe at least one surgical tool during a surgery according to thepredetermined set of rules.

According to some embodiments, the at least one location estimatingmeans is at least one endoscope adapted to acquire real-time images of asurgical environment within the human body for the estimation of thelocation of at least one surgical tool.

According to another embodiment, the location estimating means compriseat least one selected from a group consisting of optical imaging means,radio frequency transmitting and receiving means, at least one mark onat least one surgical tool and any combination thereof.

According to another embodiment, the at least one location estimatingmeans is an interface subsystem between a surgeon and at least onesurgical tool, the interface subsystem comprising (a) at least one arraycomprising N regular light sources or N pattern light sources, where Nis a positive integer; (b) at least one array comprising M cameras,where M is a positive integer; (c) optional optical markers and meansfor attaching the optical markers to at least one surgical tool; and (d)a computerized algorithm operable via the controller, the computerizedalgorithm adapted to record images received by each camera of each ofthe M cameras and to calculate therefrom the position of each of thetools, and further adapted to provide automatically the results of thecalculation to the human operator of the interface.

It is well known that surgery is a highly dynamic procedure with aconstantly changing environment which depends on many variables. Anon-limiting list of these variables includes, for example: the type ofthe surgery, the working space (e.g., with foreign objects, dynamicuncorrelated movements, etc), the type of tools used during the surgery,changing background, relative movements, dynamic procedures, dynamicinput from the operator and the history of the patient. Therefore, thereis need for a system which is able to integrate all the variables byweighting their importance and deciding to which spatial position theendoscope should be relocated.

The present invention can be also utilized to improve the interfacebetween the operators (e.g., the surgeon, the operating medicalassistant, the surgeon's colleagues, etc.). Moreover, the presentinvention can be also utilized to control and/or direct an automatedmaneuvering subsystem to focus the endoscope on an instrument selectedby the surgeon, or to any other region of interest. This may beperformed in order to estimate the location of at least one surgicaltool during a surgical procedure.

The present invention also discloses a surgical tracking system which isadapted to guide and relocate an endoscope to a predetermined region ofinterest in an automatic and/or a semi-automatic manner. This operationis assisted by an image processing algorithm(s) which is adapted toanalyze the received data from the endoscope in real time, and to assessthe surgical environment of the endoscope.

According to an embodiment, the system comprises a “smart” trackingsubsystem, which receives instructions from a maneuvering function f(t)(t is the time) as to where to direct the endoscope and which instructsthe maneuvering subsystem to relocate the endoscope to the requiredarea.

The maneuvering function f(t) receives, as input, output from at leasttwo instructing functions g_(i)(t), analyses their output and providesinstruction to the “smart” tracking system (which eventually re-directsthe endoscope).

According to some embodiments, each instructing function g_(i)(t) isalso given a weighting function, α_(i)(t).

The instructing functions g_(i)(t) of the present invention arefunctions which are configured to assess the environment of theendoscope and the surgery, and to output data which guides the trackingsubsystem for controlling the spatial position of the maneuveringsubsystem and the endoscope. The instructing functions g_(i)(t) may beselected from a group consisting of:

-   -   a. a tool detection function g₁(t);    -   b. a movement detection function g₂(t);    -   c. an organ detection function g₃(t);    -   d. a collision detection function g₄(t);    -   e. an operator input function g₅(t);    -   f. a prediction function g₆(t);    -   g. a past statistical analysis function g₇(t);    -   h. a most used tool function g₈(t);    -   i. a right tool function g₉(t);    -   j. a left tool function g₁₀(t);    -   k. a field of view function g₁₁(t);    -   l. a preferred volume zone function g₁₂(t);    -   m. a no fly zone function g₁₃(t);    -   n. a proximity function g₁₄(t);    -   o. a tagged tool function g₁₅(t);    -   p. a preferred tool function g₁₆(t).

Thus, for example, the maneuvering function f(t) receives input from twoinstructing functions: the collision detection function g₄(t) (thefunction providing information whether the distance between two elementsis smaller than a predetermined distance) and from the most used toolfunction g₈(t) (the function counts the number of times each tool ismoved during a surgical procedure and provides information as to whetherthe most moved or most used tool is currently moving). The output givenfrom the collision detection function g₄(t) is that a surgical tool isdangerously close to an organ in the surgical environment. The outputgiven from the most used tool function g₈(t) is that the tool identifiedstatistically as the most moved tool is currently moving.

The maneuvering function f(t) then assigns each of the instructingfunctions with weighting functions α_(i)(t). For example, the most usedtool function g₈(t) is assigned with a greater weight than the weightassigned to the collision detection function g₄(t).

After the maneuvering function f(t) analyses the information receivedfrom the instructing functions g_(i)(t) and the weighting functionsα_(i)(t) of each, the same outputs instructions to the maneuveringsubsystem to re-direct the endoscope (either to focus on the moving toolor on the tool approaching dangerously close to the organ).

It should be emphasized that all of the above (and the followingdisclosure) is enabled by constantly monitoring and locating/identifyingthe 3D spatial location of each element/tool in the surgicalenvironment.

The identification is provided by conventional means known to anyskilled in the art (e.g., image processing, optical means etc.).

According to some embodiments, the surgical tracking subsystemcomprises:

-   -   a. at least one endoscope adapted to acquire real-time images of        a surgical environment within the human body;    -   b. a maneuvering subsystem adapted to control the spatial        position of the endoscope during the laparoscopic surgery; and,    -   c. a tracking subsystem in communication with the maneuvering        subsystem, adapted to control the maneuvering subsystem so as to        direct and modify the spatial position of the endoscope to a        region of interest.

According to this embodiment, the tracking subsystem comprises a dataprocessor. The data processor is adapted to perform real-time imageprocessing of the surgical environment and to instruct the maneuveringsubsystem to modify the spatial position of the endoscope according toinput received from a maneuvering function f(t); the maneuveringfunction f(t) is adapted to (a) receive input from at least twoinstructing functions g_(i)(t), where i is 1, . . . , n and n≧2 andwhere t is time; i and n are integers; and (b) to output instructions tothe maneuvering subsystem based on the input from the at least twoinstructing functions g_(i)(t), so as to spatially position theendoscope to the region of interest.

According to one embodiment, the tool detection function g₁(t) isadapted to detect tools in the surgical environment. According to thisembodiment, the tool detection function is adapted to detect surgicaltools in the surgical environment and to output instructions to thetracking subsystem to instruct the maneuvering subsystem to direct theendoscope to the detected surgical tools.

According to some embodiments, the functions g_(i)(t) may rank thedifferent detected areas in the surgical environment according to aranking scale (e.g., from 1 to 10) in which prohibited areas (i.e.,areas which are defined as area to which the surgical tools areforbidden to ‘enter) receive the lowest score (e.g., 1) and preferredareas (i.e., areas which are defined as area in which the surgical toolsshould be maintained) receive the highest score (e.g., 10).

According to a preferred embodiment, one function g₁(t) is adapted todetect tools in the surgical environment and inform the maneuveringfunction f(t) if they are in preferred areas or in prohibited areas.

According to some embodiments, the movement detection function g₂(t)comprises a communicable database comprising the real-time 3D spatialpositions of each of the surgical tools in the surgical environment;means to detect movement of the at least one surgical tool when a changein the 3D spatial positions is received, and means to outputinstructions to the tracking subsystem to instruct the maneuveringsubsystem to direct the endoscope to the moved surgical tool.

According to some embodiments, the organ detection function g₃(t) isadapted to detect physiological organs in the surgical environment andto classify the detected organs as prohibited areas or preferred areas.For example, if the operator instructs the system that the specificsurgery is kidney surgery, the organ detection function g₃(t) willclassify the kidneys (or one kidney, if the surgery is specified to beon a single kidney) as a preferred area and other organs will beclassified as prohibited areas. According to another embodiment, theorgan detection function is adapted to detect organs in the surgicalenvironment and to output instructions to the tracking subsystem toinstruct the maneuvering subsystem to direct the endoscope to thedetected organs. According to some embodiments, the right tool functionis adapted to detect surgical tool positioned to right of the endoscopeand to output instructions to the tracking subsystem to instruct themaneuvering system to constantly direct the endoscope on the right tooland to track the right tool.

According to another embodiment, the left tool function is adapted todetect surgical tool positioned to left of the endoscope and to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to constantly direct the endoscope on the left tool and to trackthe left tool.

According to some embodiments, the collision detection function g₄(t) isadapted to detect prohibited areas within the surgical environment so asto prevent collisions between the endoscope and the prohibited areas.For example, if the endoscope is located in a narrow area in which aprecise movement of the same is preferred, the collision detectionfunction g₄(t) will detect and classify different areas (e.g., nerves,veins, walls of organs) as prohibited areas. Thus, according to thisembodiment, the collision prevention function is adapted to define apredetermined distance between the at least one surgical tool and ananatomical element within the surgical environment; and to outputinstructions to the tracking subsystem to instruct the maneuveringsubsystem to direct the endoscope to the surgical tool and theanatomical element within the surgical environment if the distancebetween the at least one surgical tool and an anatomical element is lessthan the predetermined distance. According to one embodiment of thepresent invention the anatomical element is selected from a groupconsisting of tissue, organ, another surgical tool and any combinationthereof.

According to some embodiments, the operator input function g₅(t) isadapted to receive an input from the operator. The input can be, forexample: an input regarding prohibited areas in the surgicalenvironment, an input regarding allowed areas in the surgicalenvironment, or an input regarding the region of interest and anycombination thereof. The operator input function g₅(t) can receiveinstructions from the operator before or during the surgery, and respondaccordingly. According to some embodiments, the operator input functionmay further comprise a selection algorithm for selection of areasselected from a group consisting of: prohibited areas, allowed areas,regions of interest, and any combination thereof. The selection may beperformed via an input device (e.g., a touch screen).

According to some embodiments, the operator input function g₅(t)comprises a communicable database; the communicable database is adaptedto receive an input from the operator of the system; the inputcomprising n 3D spatial positions; n is an integer greater than or equalto 2; and to output instructions to the tracking subsystem to instructthe maneuvering subsystem to direct the endoscope to the at least one 3Dspatial position received.

According to some embodiments, the prediction function g₆(t) is adaptedto provide data regarding a surgical environment at a time t_(f)>t₀,wherein t₀ is the present time and t_(f) is a future time. Theprediction function g₆(t) may communicate with a database which storesdata regarding the environment of the surgery (e.g., the organs in theenvironment). This data may be used by the prediction function g₆(t) forthe prediction of expected or unexpected events or expected orunexpected objects during the operation. Thus, according to thisembodiment, the prediction function g₆(t) comprises a communicabledatabase storing each 3D spatial position of each of surgical toolwithin the surgical environment, such that each movement of eachsurgical tool is stored; the prediction function is adapted to (a) topredict the future 3D spatial position of each of the surgical tools (oreach object); and, (b) to output instructions to the tracking subsystemto instruct the maneuvering subsystem to direct the endoscope to thefuture 3D spatial position.

According to some embodiments, the past statistical analysis functiong₇(t) is adapted to provide data regarding the surgical environment orthe laparoscopic surgery based on past statistical data stored in adatabase. The data regarding the surgical environment may be forexample: data regarding prohibited areas, data regarding allowed areas,data regarding the region of interest and any combination thereof. Thus,according to this embodiment, the past statistical analysis functiong₆(t) comprises a communicable database storing each 3D spatial positionof each of surgical tool within the surgical environment, such that eachmovement of each surgical tool is stored; the past statistical analysisfunction g₆(t) is adapted to (a) perform statistical analysis on the 3Dspatial positions of each of the surgical tools in the past; and, (b) topredict the future 3D spatial position of each of the surgical tools;and, (c) to output instructions to the tracking subsystem to instructthe maneuvering subsystem to direct the endoscope to the future 3Dspatial position. Thus, according to the past statistical analysisfunction g₇(t), the past movements of each tool are analyzed and,according to this analysis, a prediction of the tool's next move isprovided.

According to another embodiment, the most used tool function g₈(t)comprises a communicable database counting the amount of movement ofeach surgical tool located within the surgical environment; the mostused tool function is adapted to output instructions to the trackingsubsystem to instruct the maneuvering subsystem to direct the endoscopeto constantly position the endoscope to track the movement of the mostmoved surgical tool. The amount of movement of a tool can be defined asthe total number of movements of that tool or the total distance thetool has moved.

According to some embodiments, the right tool function g₉(t) is adaptedto detect at least one surgical tool in a specified position in relationto the endoscope, preferably positioned to right of the endoscope and tooutput instructions to the tracking subsystem to instruct themaneuvering subsystem to constantly direct the endoscope to the righttool and to track the same. According to preferred embodiments, theright tool is defined as the tool positioned to the right of theendoscope; according to other embodiments, any tool can be defined asthe right tool.

According to another embodiment, the left tool function g₁₀(t) isadapted to detect at least one surgical tool in a specified position inrelation to the endoscope, preferably positioned to left of theendoscope and to output instructions to the tracking subsystem toinstruct the maneuvering subsystem to constantly direct the endoscope tothe left tool and to track the same. According to preferred embodiments,the left tool is defined as the tool positioned to the left of theendoscope; according to other embodiments, any tool can be defined asthe left tool.

According to another embodiment, the field of view function g₁₁(t)comprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equal to 2; the combination of all of then 3D spatial positions provides a predetermined field of view; the fieldof view function is adapted to output instructions to the trackingsubsystem to instruct the maneuvering subsystem to direct the endoscopeto at least one 3D spatial position substantially within the n 3Dspatial positions so as to maintain a constant field of view.

According to another embodiment, the preferred volume zone functiong₁₂(t) comprises a communicable database comprising n 3D spatialpositions; n is an integer greater than or equal to 2; the n 3D spatialpositions provide the preferred volume zone; the preferred volume zonefunction g₁₂(t) is adapted to output instructions to the trackingsubsystem to instruct the maneuvering subsystem to direct the endoscopeto at least one 3D spatial position substantially within the preferredvolume zone.

According to another embodiment, the no fly zone function g₁₃(t)comprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equal to 2; the n 3D spatial positionsdefine a predetermined volume within the surgical environment; the nofly zone function g₁₃(t) is adapted to output instructions to thetracking subsystem to instruct the maneuvering subsystem to direct theendoscope to at least one 3D spatial position substantially differentfrom all the n 3D spatial positions.

According to some embodiments, the proximity function g₁₄(t) is adaptedto define a predetermined distance between at least two surgical tools;and to output instructions to the tracking subsystem to instruct themaneuvering subsystem to direct the endoscope to the two surgical toolsif the distance between the two surgical tools is less than or if it isgreater than the predetermined distance.

According to another embodiment, the proximity function g₁₄(t) isadapted to define a predetermined angle between at least three surgicaltools; and to output instructions to the tracking subsystem to instructthe maneuvering subsystem to direct the endoscope to the three surgicaltools if the angle between the two surgical tools is less than or if itis greater than the predetermined angle.

According to another embodiment, the preferred volume zone functioncomprises communicable database comprising n 3D spatial positions; n isan integer greater than or equals to 2; the n 3D spatial positionsprovides the preferred volume zone; the preferred volume zone functionis adapted to output instructions to the tracking subsystem to instructthe maneuvering system to direct the endoscope to the preferred volumezone.

According to another embodiment, the field of view function comprises acommunicable database comprising n 3D spatial positions; n is an integergreater than or equals to 2; the combination of all of the n 3D spatialpositions provides a predetermined field of view; the field of viewfunction is adapted to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to at least one3D spatial position substantially within the n 3D spatial positions soas to maintain a constant field of view.

According to another embodiment, the no fly zone function comprises acommunicable database comprising n 3D spatial positions; n is an integergreater than or equals to 2; the n 3D spatial positions define apredetermined volume within the surgical environment; the no fly zonefunction is adapted to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to at least one3D spatial position substantially different from all the n 3D spatialpositions.

According to another embodiment, the most used tool function comprises acommunicable database counting the amount of movement of each surgicaltool located within the surgical environment; the most used toolfunction is adapted to output instructions to the tracking subsystem toinstruct the maneuvering system to direct the endoscope to constantlyposition the endoscope to track the movement of the most moved surgicaltool.

According to some embodiments, the prediction function g₆(t) is adaptedto provide data regarding a surgical environment in a time t_(f)>t,wherein t is the present time and t_(f) is the future time. Theprediction function g₆(t) may communicate with a database which storesdata regarding the environment of the surgery (e.g., the organs in theenvironment). This data may be used by the prediction function g₆(t) forthe prediction of expected or unexpected events or object during theoperation. Thus, according to this embodiment, the prediction functioncomprises a communicable database storing each 3D spatial position ofeach of surgical tool within the surgical environment, such that eachmovement of each surgical tool is stored; the prediction function isadapted to (a) to predict the future 3D spatial position of each of thesurgical tools; and, (b) to output instructions to the trackingsubsystem to instruct the maneuvering system to direct the endoscope tothe future 3D spatial position.

According to some embodiments, the past statistical analysis functiong₇(t) is adapted to provide data regarding the surgical environment orthe laparoscopic surgery based on past statistical data stored in adatabase. The data regarding the surgical environment may be forexample: data regarding prohibited areas, data regarding allowed areas,data regarding the region of interest. Thus, according to thisembodiment, the past statistical analysis function comprises acommunicable database storing each 3D spatial position of each ofsurgical tool within the surgical environment, such that each movementof each surgical tool is stored; the past statistical analysis functionis adapted to (a) statistical analyze the 3D spatial positions of eachof the surgical tools in the past; and, (b) to predict the future 3Dspatial position of each of the surgical tools; and, (c) to outputinstructions to the tracking subsystem to instruct the maneuveringsystem to direct the endoscope to the future 3D spatial position. Thus,according to the past statistical analysis function g₇(t), the pastmovements of each tool are analyzed and according to this analysis afuture prediction of the tool's next move is provided.

According to some embodiments, preferred tool function comprises acommunicable database, the database stores a preferred tool; thepreferred tool function is adapted to output instructions to thetracking subsystem to instruct the maneuvering system to constantlydirect the endoscope to the preferred tool, such that said endoscopeconstantly tracks said preferred tool.

Thus, according to the preferred tool function the endoscope constantlytracks the preferred tool, such that the field of view, as seen from theendoscope, is constantly maintained on said preferred tool. It should benoted that the user may define in said preferred tool function toconstantly tack the tip of said preferred tool or alternatively, theuser may define in said preferred tool function to constantly track thebody or any location on the preferred tool.

According to some embodiments, the tagged tool function g₁₅(t) comprisesmeans adapted to tag at least one surgical tool within the surgicalenvironment and to output instructions to the tracking subsystem toinstruct the maneuvering subsystem to constantly direct the endoscope tothe tagged surgical tool. Thus, according to the tagged tool functionthe endoscope constantly tracks the preferred (i.e., tagged) tool, suchthat the field of view, as seen from the endoscope, is constantlymaintained on said preferred (tagged) tool. It should be noted that theuser may define in said tagged tool function to constantly tack the tipof said preferred (tagged) tool or alternatively, the user may define insaid tagged tool function to constantly track the body or any locationon the preferred (tagged) tool.

According to some embodiments, the means are adapted to constantly tagthe at least one of surgical tool within the surgical environment.

According to some embodiments, the preferred tool function g₁₆(t)comprises a communicable database. The database stores a preferred tool;and the preferred tool function is adapted to output instructions to thetracking subsystem to instruct the maneuvering subsystem to direct theendoscope to the preferred tool.

According to some embodiments, the system further comprises meansadapted to re-tag the at least one of the surgical tools until a desiredtool is selected.

According to some embodiments, the system further comprises meansadapted to toggle the surgical tools. According to some embodiments, thetoggling is performed manually or automatically.

According to different embodiments of the present invention, theweighting functions α_(i)(t) are time-varying functions (or constants),the value of which is determined by the operator or the output of theinstructing functions g_(i)(t). For example, if a specific functiong_(i)(t) detected an important event or object, its weighting functionsα_(i)(t) may be adjusted in order to elevate the chances that themaneuvering function f(t) will instruct the maneuvering subsystem tomove the endoscope towards this important event or object.

According to different embodiments of the present invention, thetracking subsystem may implement various image processing algorithmswhich may also be algorithms that are well known in the art. The imageprocessing algorithms may be for example: image stabilizationalgorithms, image improvement algorithms, image compilation algorithms,image enhancement algorithms, image detection algorithms, imageclassification algorithms, image correlations with the cardiac cycle orthe respiratory cycle of the human body, smoke reduction algorithms,vapor reduction algorithms, steam reduction algorithms and anycombination thereof. Smoke, vapor and steam reduction algorithms may beneeded as it is known that, under certain conditions, smoke, vapor orsteam may be emitted by or from the endoscope. The image processingalgorithm may also be implemented and used to analyze 2D or 3Drepresentations which may be rendered from the real-time images of thesurgical environment.

According to different embodiments, the endoscope may comprise an imageacquisition device selected from a group consisting of: a camera, avideo camera, an electromagnetic sensor, a computer tomography imagingdevice, a fluoroscopic imaging device, an ultrasound imaging device, andany combination thereof.

According to some embodiments, the system may also comprise a displayadapted to provide input or output to the operator regarding theoperation of the system. The display may be used to output the acquiredreal-time images of a surgical environment with augmented realityelements. The display may also be used for the definition of the regionof interest by the operator.

According to some embodiments, the endoscope may be controlled be anendoscope controller for performing operations such as: acquiring thereal-time images and zooming-in to a predetermined area. For example,the endoscope controller may cause the endoscope to acquire thereal-time images in correlation with the cardiac cycle or therespiratory cycle of a human body.

According to different embodiments, the data processor of the presentinvention may operate a pattern recognition algorithm for assisting theoperation of the instructing functions g_(i)(t). The pattern recognitionalgorithm may be used as part of the image processing algorithm.

It should be emphasized that all of the above (and the followingdisclosure) is enabled by constantly monitoring and locating/identifyingthe 3D spatial location of each element/tool in the surgicalenvironment.

The identification is provided by conventional means known to anyskilled in the art (e.g., image processing, optical means etc.).

The present invention further discloses a method for assisting anoperator to perform a surgical procedure, comprising steps of:

-   -   a. providing a surgical controlling system, comprising: (i) at        least one surgical tool; (ii) at least one location estimating        means; and (iii) a controller having a processing means        communicable with a database;    -   b. inserting the at least one surgical tool into a surgical        environment of a human body;    -   c. estimating the location of the at least one surgical tool        within the surgical environment; and,    -   d. controlling the spatial position of the at least one surgical        tool within the surgical environment by means of the controller;        wherein the step of controlling is performed by storing a        predetermined set of rules in the database where the        predetermined set of rules comprises ALLOWED and RESTRICTED        movements of the at least one surgical tool, such that the        spatial position of the at least one surgical tool is controlled        by the controller according to the ALLOWED and RESTRICTED        movements.

The present invention also discloses a method for assisting an operatorto perform laparoscopic surgery on a human body. The method comprisessteps of:

-   -   a. providing a surgical tracking system, comprising: (i) at        least one endoscope adapted to acquire real-time images of a        surgical environment within the human body; (ii) a maneuvering        subsystem in communication with the endoscope; and (iii) a        tracking subsystem in communication with the maneuvering        subsystem, the tracking subsystem comprising a data processor;    -   b. performing real-time image processing of the surgical        environment;    -   c. controlling the maneuvering subsystem via the tracking        subsystem, thereby directing and modifying the spatial position        of the endoscope to a region of interest according to input        received from a maneuvering function f(t);    -   the maneuvering function f(t) is adapted to (a) receive input        from at least two instructing functions g_(i)(t), where i is 1,        . . . , n and n≧2; where t is time; i and n are integers;        and (b) to output instructions to the maneuvering subsystem        based on the input from the at least two instructing functions        g_(i)(t), so as to spatially position the endoscope to the        region of interest.

It should be emphasized that all of the above (and the followingdisclosure) is enabled by constantly monitoring and locating/identifyingthe 3D spatial location of each element/tool in the surgicalenvironment.

The identification is provided by conventional means known to anyskilled in the art (e.g., image processing, optical means etc.).

The present invention further discloses a surgical controlling system,comprising:

-   -   a. at least one endoscope adapted to provide real-time image of        surgical environment of a human body;    -   b. at least one processing means, adapted to real time define n        element within the real-time image of surgical environment of a        human body; each of the elements is characterized by        predetermined characteristics;    -   c. image processing means in communication with the endoscope,        adapted to image process the real-time image and to provide real        time updates of the predetermined characteristics;    -   d. a communicable database, in communication with the processing        means and the image processing means, adapted to store the        predetermined characteristics and the updated characteristics;    -   the system is adapted to notify the operator if the updated        characteristics are substantially different from the        predetermined characteristics.

Thus, according to this embodiment, each element in the surgicalenvironment is characterized. The characteristics are constantlymonitored. If the characteristics change substantially, the systemnotifies the user.

For example, the element that is monitored could be an organ and thecharacteristic being monitored is its contours. Once the contours havesignificantly changed (which could imply that the organ has been e.g.,carved) the system alerts the user.

It should be emphasized that all of the above is enabled by constantlymonitoring and locating/identifying the 3D spatial location of eachelement/tool in the surgical environment.

The identification is provided by conventional means known to anyskilled in the art (e.g., image processing, optical means etc.).

According to another embodiment, the predetermined characteristics areselected from a group consisting of: color of the element, 3D spatiallocation of the element, contours of the element, and any combinationthereof.

According to another embodiment, the system additionally comprises atleast one surgical tool adapted to be inserted into a surgicalenvironment of a human body for assisting a surgical procedure.

According to another embodiment, the system additionally comprises atleast one location estimating means adapted to estimate the location ofthe at least one surgical tool.

According to another embodiment, the system additionally comprises acontroller having a processing means communicable with a database, thecontroller adapted to control the spatial position of the at least onesurgical tool.

The present invention further provides a method for controlling surgery,comprising steps of:

-   a. obtaining a system comprising:    -   i. at least one endoscope adapted to provide real-time image of        a surgical environment in a human body;    -   ii. at least one processing means, adapted to define in real        time n elements within the real-time image of the surgical        environment of a human body, n is an integer greater than 0;        each of the elements characterized by predetermined        characteristics;    -   iii. image processing means in communication with the endoscope,        adapted to process the real-time image and to provide real time        updates of the predetermined characteristics;    -   iv. a communicable database, in communication with the        processing means and the image processing means, adapted to        store the predetermined characteristics and the updated        characteristics;-   b. providing a real-time image of a surgical environment in a human    body;-   c. defining the n elements;-   d. characterizing each of the elements by the predetermined    characteristics;-   e. providing a real-time update of the predetermined    characteristics;-   f. notifying the user if the updated characteristics are    substantially different from the predetermined characteristics.

According to another embodiment, the predetermined characteristics areselected from a group consisting of: color of the element, 3D spatiallocation of the element, contours of the element and any combinationthereof.

According to another embodiment, the method additionally comprises astep of providing at least one surgical tool adapted to be inserted intoa surgical environment of a human body for assisting a surgicalprocedure.

According to another embodiment, the method additionally comprises astep of providing at least one location estimating means adapted toestimate the location of the at least one surgical tool.

According to another embodiment, the method additionally comprises astep of providing a controller having a processing means communicablewith a database, the controller adapted to control the spatial positionof the at least one surgical tool.

According to another embodiment, the system of the present inventionadditionally comprises an image processing unit. According to anotherembodiment, the image processing unit is adapted to reduce ‘noise’ fromthe received image by reducing the visibility in the image of the smokecaused by e.g., coagulation. According to another embodiment, the imageprocessing unit is adapted to reduce ‘noise’ from the received image byreducing the visibility in the image of vapor or steam accumulated onthe endoscope.

According to another embodiment, the right tool function is adapted toinstruct the maneuvering subsystem to constantly position the endoscopeto track the movement of the right tool (i.e., the tool positioned tothe right of the endoscope).

According to another embodiment, the left tool function is adapted toinstruct the maneuvering subsystem to constantly position the endoscopeto track the movement of the left tool (i.e., the tool positioned to theleft of the endoscope).

According to another embodiment, the field of view function is adaptedto instruct the maneuvering subsystem to constantly position theendoscope so as to maintain a constant field of view.

According to another embodiment, the no fly zone function is adapted todefine (either real-time, during the procedure or prior to theprocedure) a no fly zone and to instruct the maneuvering subsystem torestrict entrance of the endoscope to the no fly zone.

According to another embodiment, the most used tool function is adaptedto define (either real-time, during the procedure or prior to theprocedure) which tool is the most used tool (i.e., the tool which ismoved the most during the procedure) and to instruct the maneuveringsubsystem to constantly position the endoscope to track the movement ofthe most-used tool.

The following figures provide examples of several of the above mentionedrules and functions.

Reference is made now to FIG. 1A, which is a general schematic view of aspecific embodiment of a surgical tracking system 100. In this figureare illustrated surgical instruments 17 b and 17 c and an endoscope 21which may be maneuvered by means of maneuvering subsystem 19 accordingto the instructions received from a tracking subsystem operable bycomputer 15.

According to one embodiment of the present invention as defined in theabove, the user may define the field of view function as constantlymonitoring at least one of surgical instruments 17 b and 17 c.

According to this embodiment, the surgical tracking system 100 may alsocomprise one or more button operated wireless transmitters 12 a, whichtransmit, upon activation, a single code wave 14 through aerial 13 toconnected receiver 11 that produces a signal processed by computer 15,thereby directing and modifying the spatial position of endoscope 21 tothe region of interest, as defined by the field of view function.

Alternatively, according to the proximity rule, if the distance betweenthe surgical instruments 17 b and 17 c is smaller than a predetermineddistance (as defined by the collision prevention rule), the systemalerts the user that any movement of either one of the surgicalinstruments 17 b and 17 c that will reduce the distance is a RESTRICTEDmovement.

Reference is made now to FIG. 1B, which schematically illustrates theoperation of the present invention. According to this figure, the systemof the present invention comprises a display 30 in which the overallprocedure is presented to the operator. In this figure an endoscope isautomatically spatially repositioned towards a region of interest 38.

The region of interest to which the endoscope is repositioned comprisestools 37 b and 37 c, which are automatically detected by the trackingsubsystem (not shown) of computer 15. According to differentembodiments, the repositioning of the endoscope may be automatic orsemi-automatic. For example, according to FIG. 1B, a light depression ofthe button on generic code-emitting wireless transmitter 12 a causestransmission of a code that is received by receiver aerial 13communicated through connected receiver 11 to computer 15. Thisoperation causes the endoscope of the present invention to be spatiallyrepositioned to the predefined region of interest (e.g., the location inwhich the working tools are located). According to this embodiment ofthe present invention, the operator may define the region of interest asthe region in which a tip 35 b of tool 37 b is found.

According to another embodiment, the operator can define one of thesurgical instruments 17 b and 17 c as a preferred tool. Thus, accordingto the preferred tool rule, the endoscope will constantly monitor andtrack the body of the selected tool. According to another embodiment,the user can define the preferred tool rule to constantly reposition theendoscope on the tip of the same (see tip 35 b in FIG. 1B).

According to the embodiment illustrated in FIG. 1B, the activation ofthe system is provided by a button that signals to the system that it isto be activated.

According to another embodiment of the present invention, the button canbe coupled to the desired tool to be monitored, such that the endoscopewill monitor the tool to which the button is coupled (and from whichsignal 12 a is emitted).

Referring again to FIG. 1B, once a region of interest has been defined,the tracking subsystem is adapted to look for tip 35 b within the regionof interest by performing image processing. When tip 35 b is notdetected by the tracking subsystem, the system can move the endoscope ina forward direction along a predefined track. When tip 35 b is detectedby the tracking subsystem, the endoscope automatically focuses of theregion of interest.

While performing the surgery, the surgeon often changes the position ofhis tools and even their insertion point. In order to realize a positionand range system, many well-known technologies may be used. For example,the tools may be equipped with switches. If the switches emit wirelesssignals, then an array of antennas may be used to compare the power ofthe signal received at each antenna in order to determine the angle ofthe switch and its approximate range to the camera holder mechanism. Ifthe switch emits ultrasound then ultrasound-sensitive microphones can beused to triangulate the position of the switch. The same is true for alight-emitting switch. In a preferred embodiment of the invention, asingle wireless emission code is utilized and choice is achieved by avisible graphic representation on a conventional viewing screen.

In another preferred embodiment, each instrument is fitted with a uniquecode wireless transmitter, and selection is achieved by depressing itsbutton.

According to different embodiments, the tracking subsystem of thepresent invention may be used in any conventional camera-assistedlaparoscopic surgery system which comprises an endoscope. Upondepression of at least one button on a transmitter for activating thetracking subsystem, either a generic or a unique code is transmitted toa receiving device connected to a computer that instructs themaneuvering subsystem to reposition the endoscope to a region ofinterest.

For example, the system of the present invention may be used to allow anoperator (e.g., a surgeon) to present the surgical instrument tosurgical colleagues and staff. By identifying the surgical instrumentvia the tracking subsystem, the endoscope directs the view to thepredefined region of interest.

According to some embodiments, the tracking subsystem may identify asurgical tool after characterization of the same prior to the surgery.The characteristics of the surgical tool may be stored in a database forfurther use in the image processing algorithm. Upon depression of atleast one button, the tracking subsystem may instruct the maneuveringsubsystem to move the endoscope so as to achieve the desired focus on aspecific region of interest.

The device of the present invention has many technological advantages,among them:

-   -   Simplifying the communication interface between surgeon and        mechanical assistants.    -   Seamless interaction with conventional computerized automated        endoscope systems.    -   Simplicity of construction and reliability.    -   User-friendliness.

Additional features and advantages of the invention will become apparentfrom the following drawings and description.

To improve the control of the endoscope, the system of the presentinvention comprises a maneuvering subsystem. Many maneuvering systemsare known in the art and many of them have several degrees of freedom:

-   (a) one degree of freedom enables the system to move the endoscope    or laparoscope forward and backwards;-   (b) another degree of freedom enables the system to move the    endoscope or laparoscope in a zoom movement i.e. in and out of the    patient's body through the penetration point;-   (c) another degree of freedom enables the system to move the    endoscope or laparoscope to the right and left;-   (d) another degree of freedom enables the system to fine tune    endoscope or laparoscope movements to the right and to the left;-   (e) another degree of freedom enables the system to fine tune    endoscope or laparoscope movements forward and backwards;-   (f) another degree of freedom enables the system to rotate the    camera with respect to the endoscope's long axis. This degree of    freedom is necessary to keep the horizon of the image from changing    when using an endoscope with “angled edge”.

Such maneuvering systems are utilized by the present invention so as toreposition the endoscope to the desired location.

The present invention is utilized to improve upon the interface betweensurgeon and automated assistants by communicating the surgeon's currentinstrument of choice, supplying location data to the image processingcomputing software, thereby directing the endoscope to focus on thatchoice. The technology relies on marrying a conventional laparoscopicsystem with data obtained from e.g., small RF transmitters attached to asurgical tool or, alternatively, data obtained from light emitters(e.g., LED bulbs) attached to a surgical tool.

It will be apparent to one skilled in the art that there are severalembodiments of the invention that differ in details of construction,without affecting the essential nature thereof, and therefore theinvention is not limited by that which is illustrated in the figures anddescribed in the specification, but only as indicated in theaccompanying claims, with the proper scope determined only by thebroadest interpretation of the claims.

FIG. 2 a shows an example of using the system of the present inventionin abdominal laparoscopic surgery.

FIG. 2 b shows an example of using the system of the present inventionin knee endoscopic surgery.

Lastly, FIG. 2 c shows an example of using the system of the presentinvention in shoulder endoscopic surgery.

EXAMPLES

Examples are given in order to prove the embodiments claimed in thepresent invention. The example, which is a clinical test, describes themanner and process of the present invention and set forth the best modecontemplated by the inventors for carrying out the invention, but arenot to be construed as limiting the invention.

In the examples below, similar numbers refer to similar parts in all ofthe figures.

Example 1 Tracking System with Collision Avoidance System

One embodiment of such a rule-based system will comprise the followingset of commands:

Detection (denoted by Gd):

Gd1 Tool location detection function

Gd2 Organ (e.g. Liver) detection function

Gd3 Movement (vector) calculation and estimation function

Gd4 Collision probability detection function

Tool Instructions (denoted Gt):

Gt1 Move according to manual command

-   -   Gt2 Stop movement

The scenario—manual move command by the surgeon:

Locations Gd1(t) and Gd2(t) are calculated in real time at each timestep (from an image or location marker).

Tool movement vector Gd3(t) is calculated from Gd1(t) as the differencebetween the current location and at least one previous location(probably also taking into account previous movement vectors).

The probability of collision—Gd4(t)—is calculated, for example, from thedifference between location Gd1 and location Gd2 (the smaller thedistance, the closer the proximity and the higher the probability ofcollision), from movement vector Gd3(t) indicating a collision, etc.

Tool Instructions Gt1 Weight function α₁(t)=1 If Gt1(t)<a predeterminedthreshold and 0 otherwise

Tool Instructions Gt2 Weight function α₂(t)=1 If Gt2(t)>a predeterminedthreshold and 0 otherwise

Tool Instructions=α₁(t)*Gt1+α₂(t)*Gt2(t);

In reference to FIG. 3, which shows, in a non-limiting manner, anembodiment of a tracking system and collision avoidance system. Thesystem tracks a tool 310 and the liver 320, in order to determinewhether a collision between the tool 310 and the liver 320 is possiblewithin the next time step. FIGS. 3 a and 3 b show how the behavior ofthe system depends on the distance 330 between the tool 310 and theliver 320, while FIGS. 3 c and 3 d show how movement of the tool 310affects the behavior. In FIG. 3 a, the distance 330 between the tool 310and the liver 320 is large enough that a collision is not possible inthat time step. Since no collision is possible, no movement of the toolis commanded. In FIG. 3 b, the distance 330 between the tool 310 and theliver 320 is small enough that a collision is likely. In the embodimentillustrated, a movement 340 is commanded to move the tool 310 away fromthe liver 320. In other embodiments, the system prevents movement 350,but does not command movement 340; in such embodiments, the tool 310will remain close to the liver 320. In yet other embodiments, the systemwarns/signals the operator that the move is RESTRICTED, but does notrestrict movement 350 or command movement 340 away from the liver. Sucha warning/signaling can be visual or aural, using any of the methodsknown in the art.

FIGS. 3 c and 3 d illustrate schematically the effect of the movement oftool 310 on the collision avoidance system. In FIGS. 3 c and 3 d, thetool 310 is close enough to the liver 320 that a collision between thetwo is possible. If the system tracked only the positions of the tool310 and the liver 320, then motion of the tool 310 away from the liver320 would be commanded. FIG. 3 c illustrates the effect of a movement350 that would increase the distance between tool 310 and liver 320.Since the movement 350 is away from liver 320, no collision is possiblein this time step and no movement of the tool 310 is commanded.

In FIG. 3 d, tool 310 is the same distance from liver 320 as in FIG. 3c. However, in FIG. 3 d, the movement 350 of the tool 310 is toward theliver 320, making a collision between tool 310 and liver 320 possible.In some embodiments, a movement 340 is commanded to move the tool 310away from the liver 320. In other embodiments, the system preventsmovement 350, but does not command movement 340; in this embodiment thetool 310 will remain close to the liver 320. In yet other embodiments,the system warns the operator that move is RESTRICTED, but does notrestrict movement 350 or command movement 340 away from the liver. Sucha warning can be visual or aural, using any of the methods known in theart.

As a non-limiting example, in an operation on the liver, the collisiondetection function can warn the operator that a collision between a tooland the liver is likely but not prevent the collision. In an operationon the gall bladder, the collision detection function can prevent acollision between the tool and the liver, either by preventing themovement or by commanding a movement redirecting the tool away from theliver,

Example 2 Tracking System with Soft Control—Fast Movement when Nothingis Nearby, Slow Movement when Something is Close

One embodiment of such rule-based system comprises the following set ofcommands:

Detection (denoted by Gd):

Main Tool location detection function (denoted by GdM);

Gd-tool1-K—Tool location detection function;

Gd-organ2-L—Organ (e.g. Liver) detection function;

Gd3 Main Tool Movement (vector) calculation and estimation function;

Gd4 Proximity probability detection function;

Tool Instructions (denoted Gt):

Gt1 Movement vector (direction and speed) according to manual command

The scenario—manual move command by the surgeon:

Locations GdM(t), Gd-tool1-K(t) and Gd-organ2-L(t) are calculated inreal time at each time step (from image or location marker).

Main Tool Movement Vector Gd3(t) is calculated per GdM(t) as thedifference between the current location and at least one previouslocation (probably also taking into account previous movement vectors)

The proximity of the main tool to other tools—Gd4(t)—is calculated, forexample, as the smallest of the differences between the main toollocation and the other tools' locations.

Tool Instructions Gt1 Weight function ai(t) is proportional to toolproximity function Gd4(t), the closer the tool the slower the movementso that, for example

α₂(t)=Gd4/maximum(Gd4)

or

α₂(t)=log(Gd4/maximum(Gd4)) where maximum(Gd4) is the maximum distancewhich is likely to result in a collision given the distances, the speedof the tool and the movement vector.

Tool Instructions=α₁(t)*Gt1.

Example 3 Tracking System with No-Fly Rule/Function

In reference to FIG. 4, which shows, in a non-limiting manner, anembodiment of a tracking system with no-fly rule. The system tracks atool 310 with respect to a no-fly zone (460), in order to determinewhether the tool will enter the no-fly zone (460) within the next timestep. In this example, the no-fly zone 460 surrounds the liver.

FIGS. 4 a and 4 b show how the behavior of the system depends on thelocation of the tool tip with respect to the no-fly zone, while FIGS. 4c and 4 d show how movement of the tool affects the behavior.

In FIG. 4 a, the tool 310 is outside the no-fly zone rule/function 460and no movement of the tool is commanded. In FIG. 4 b, the tool 310 isinside the no-fly zone 460.

The no-fly zone rule/function performs as follows:

In the embodiment illustrated, a movement 350 is commanded to move thetool 310 away from the no-fly zone 460. In other embodiments, the systemprevents movement further into the no-fly zone (refers as movement 340,see FIG. 4 c), but does not command movement 340; in such embodiments,the tool 310 will remain close to the no-fly zone 460.

In yet other embodiments, the system warns/signals the operator that themove is RESTRICTED, but does not restrict movement further into theno-fly zone or command movement 340 away from the no-fly zone 460. Sucha warning/signaling can be visual or aural, using any of the methodsknown in the art.

FIGS. 4 c and 4 d illustrate schematically the effect of the tool'smovement on operation of the no-fly zone rule/function. In FIGS. 4 c and4 d, the tool 310 is close enough to the no-fly zone 460 (distance 330is small enough) that it is possible for the tool to enter the no-flyzone during the next time step. FIG. 4 c illustrates the effect of amovement 340 that would increase the distance between tool 310 andno-fly zone 460. Since the movement 340 is away from no-fly zone 460, nocollision is possible in this time step and no movement of the tool 310is commanded.

In FIG. 4 d, tool 310 is the same distance from no-fly zone 460 as inFIG. 4 c. However, in FIG. 4 d, the movement 340 of the tool is towardno-fly zone 460, making it possible for tool 310 to enter no-fly zone460. In the embodiment illustrated, a movement 350 is commanded to movethe tool 310 away from the no-fly zone 460. In other embodiments, thesystem prevents movement 340, but does not command movement 350; in suchembodiments, the tool 310 will remain close to the no-fly zone 460. Inyet other embodiments, the system warns/signals the operator that themove is RESTRICTED, but does not restrict movement 340 or commandmovement 350 away from the no-fly zone rule/function 460. Such awarning/signaling can be visual or aural, using any of the methods knownin the art.

Example 4 Tracking System with Preferred Volume Zone Rule/Function

In reference to FIG. 5, which shows, in a non-limiting manner, anembodiment of a tracking system with a preferred volume zonefunction/rule.

The system tracks a tool 310 with respect to a preferred volume zone(570), in order to determine whether the tool will leave the preferredvolume (570) within the next time step.

In this example, the preferred volume zone 570 extends over the rightlobe of the liver. FIGS. 5 a and 5 b show how the behavior of the systemdepends on the location of the tool tip with respect to the preferredvolume zone 570, while FIGS. 5 c and 5 d show how movement of the toolaffects the behavior (i.e., the preferred volume zone rule/function).

In FIG. 5 a, the tool 310 is inside the preferred volume zone 570 and nomovement of the tool is commanded. In FIG. 5 b, the tool 310 is outsidethe preferred volume zone 570.

In the embodiment illustrated, a movement 340 is commanded to move thetool 310 away from the preferred volume zone 570. In other embodiments,the system prevents movement 340; in such embodiments, the tool 310 willremain close to the preferred volume zone 570. In yet other embodiments,the system warns/signals the operator that the move 340 is RESTRICTED.Such a warning/signaling can be visual or aural, using any of themethods known in the art.

FIGS. 5 c and 5 d illustrate schematically the effect of the tool'smovement on operation of the preferred volume rule/function. In FIGS. 5c and 5 d, the tool 310 is close enough to the edge of preferred volumezone 570 that it is possible for the tool to leave the preferred volumezone during the next time step.

FIG. 5 c illustrates the effect of a movement 350 that would take thetool 310 deeper into preferred volume zone 570. Since the movement 350is into preferred volume 570, said movement is an allowed movement.

In FIG. 5 d, the movement 350 of the tool is out of the preferred volume570, making it possible for tool 310 to leave preferred volume 570.

According to one embodiment illustrated, a movement 340 is commanded tomove the tool 310 into the preferred volume zone 570. In otherembodiments, the system prevents movement 350, but does not commandmovement 340; in such embodiments, the tool 310 will remain close to thepreferred volume zone 570. In yet other embodiments, the systemwarns/signals the operator that the move is RESTRICTED, but does notrestrict movement 350 or command movement 340 away from the preferredvolume zone 570. Such a warning/signaling can be visual or aural, usingany of the methods known in the art.

Example 5 Organ/Tool Detection Function

In reference to FIG. 6, which shows, in a non-limiting manner, anembodiment of an organ detection system (however, it should be notedthat the same is provided for detection of tools, instead of organs).

For each organ, the 3D spatial positions of the organs stored in adatabase. In FIG. 6, the perimeter of each organ is marked, to indicatethe edge of the volume of 3D spatial locations stored in the database.

In FIG. 6, the liver 610 is labeled with a dashed line. The stomach 620is labeled with a long-dashed line, the intestine 630 with a solid lineand the gall bladder 640 is labeled with a dotted line.

In some embodiments, a label or tag visible to the operator is alsopresented. Any method of displaying identifying markers known in the artcan be used. For non-limiting example, in an enhanced display, coloredor patterned markers can indicate the locations of the organs, with themarker either indicating the perimeter of the organ or the area of thedisplay in which it appears.

Example 6 Tool Detection Function

In reference to FIG. 7, which shows, in a non-limiting manner, anembodiment of a tool detection function. For each tool, the 3D spatialpositions of the tools stored in a database. In FIG. 7, the perimeter ofeach tool is marked, to indicate the edge of the volume of 3D spatiallocations stored in the database. In FIG. 7, the left tool is labeledwith a dashed line while the right tool is labeled with a dotted line.

In some embodiments, a label or tag visible to the operator is alsopresented. Any method of displaying identifying markers known in the artcan be used. For non-limiting example, in an enhanced display, coloredor patterned markers can indicate the locations of the tools, with themarker either indicating the perimeter of the tool or the area of thedisplay in which it appears.

Example 7 Movement Detection Function/Rule

In reference to FIG. 8, which shows, in a non-limiting manner, anembodiment of a movement detection function/rule. FIG. 8 a schematicallyillustrates a liver 810, a left tool 820 and a right tool 830 at a timet. FIG. 8 b schematically illustrates the liver 810, left tool 820 andright tool 830 at a later time t+Δt, where Δt is a small time interval.In this example, the left tool 820 has moved downward (towards thedirection of liver 810) in the time interval Δt.

The system has detected movement of left tool 820 and labels it. This isillustrated schematically in FIG. 8 b by a dashed line around left tool820.

Example 8 Prediction Function

In reference to FIG. 9, which shows, in a non-limiting manner, anembodiment of the above discussed prediction function.

FIG. 9 a shows a left tool 920 and a right tool 930 at a time t.

FIG. 9 b shows the same tools at a later time t+Δt, where Δt is a smalltime interval. Left tool 920 is moving to the right and downward, whileright tool 930 is moving to the left and upward. If the motion continues(shown by the dashed line in FIG. 9 c), then by the end of the next timeinterval, in other words, at some time between time t+Δt and time t+2Δt,the tools will collide, as shown by tool tips within the dotted circle950 in FIG. 9 c.

In this embodiment, the system automatically prevents predictedcollisions and, in this example, the system applies a motion 940 toredirect left tool 920 so as to prevent the collision.

In other embodiments, the system warns/signals the operator that acollision is likely to occur, but does not alter the movement of anytool. Such a warning/signaling can be visual or aural, using any of themethods known in the art.

In other embodiments, the prediction function can be enabled to, fornon-limiting example, alter the field of view to follow the predictedmovement of a tool or of an organ, to warn of (or prevent) predictedmotion into a no-fly zone, to warn of (or prevent) predicted motion outof a preferred zone.

Example 9 Right Tool Function/Rule

In reference to FIG. 10, which shows, in a non-limiting manner, anembodiment of a right tool function. FIG. 10 schematically illustrates aliver 1010, a left tool 1020 and a right tool 1030. The right tool,illustrated schematically by the dashed line 1040, is labeled and its 3Dspacial location is constantly and real-time stored in a database. Now,according to the right tool function/rule the endoscope constantlytracks the right tool.

It should be pointed out that the same rule/function applies for theleft tool (the left tool function/rule).

Example 10 Field of View Function/Rule

In reference to FIG. 11, which shows, in a non-limiting manner, anembodiment of a field of view function/rule.

FIG. 11 a schematically illustrates a field of view of the abdomen at atime t. In the field of view are the liver 1110, stomach 1120,intestines 1130 and gall bladder 1140.

The gall bladder is nearly completely visible at the left of the fieldof view. Two tools are also in the field of view, with their tips inproximity with the liver. These are left tool 1150 and right tool 1160.In this example, the field of view function/rule tracks left tool 1150.In this example, left tool 1150 is moving to the right, as indicated byarrow 1170.

FIG. 11 b shows the field of view at time t+Δt. The field of view hasmoved to the right so that the tip of left tool 1150 is still nearly atthe center of the field of view. It can be seen that much less of gallbladder 1140 is visible, while more of right tool 1160 has entered thefield of view.

The field of view function/rule can be set to follow a selected tool, asin this example or to keep a selected organ in the center of the fieldof view. It can also be set to keep a particular set of tools in thefield of view, zooming in or out as necessary to prevent any of thechosen tools from being outside the field of view.

Alternatively, the field of view function/rule defines n 3D spatialpositions; n is an integer greater than or equal to 2; the combinationof all of said n 3D spatial positions provides a predetermined field ofview.

Each movement of the endoscope or the surgical tool within said n 3Dspatial positions is an allowed movement and any movement of theendoscope or the surgical tool outside said n 3D spatial positions is arestricted movement.

Alternatively, said the field of view function/rule defines n 3D spatialpositions; n is an integer greater than or equal to 2; the combinationof all of said n 3D spatial positions provides a predetermined field ofview.

According to the field of view function/rule, the endoscope is relocatedif movement has been detected by said detection means, such that saidfield of view is maintained.

Example 11 Tagged Tool Function/Rule (or Alternatively the PreferredTool Rule)

In reference to FIG. 12, which shows, in a non-limiting manner, anembodiment of a tagged tool function/rule.

FIG. 12 shows three tools (1220, 1230 and 1240) in proximity to theorgan of interest, in this example, the liver 1210.

The tool most of interest to the surgeon, at this point during theoperation, is tool 1240. Tool 1240 has been tagged (dotted line 1250);the 3D spacial location of tool 1240 is constantly stored in a databaseand this spacial location has been labeled as one of interest.

The system can use this tagging for many purposes, including, but notlimited to, keeping tool 1240 in the center of the field of view,predicting its future motion, keeping it from colliding with other toolsor keeping other tools from colliding with it, instructing the endoscopeto constantly monitor and track said tagged tool 1250 and so on.

It should be noted that in the preferred tool rule, the system tags oneof the tools and performs as in the tagged tool rule/function.

Example 12 Proximity Function/Rule

In reference to FIG. 13, which shows, in a non-limiting manner, anembodiment of a proximity function/rule.

FIG. 13 a schematically illustrates two tools (1310 and 1320) separatedby a distance 1330 which is greater than a predefined proximitydistance. Since tool 1310 is not within proximity of tool 1320, thefield of view (1380) does not move.

FIG. 13 b schematically illustrates two tools (1310 and 1320) separatedby a distance 1330 which is less than a predefined proximity distance.

Since tool 1310 is within proximity of tool 1320, the field of view 1380moves upward, illustrated schematically by arrow 1340, until the tips oftool 1310 and tool 1320 are in the center of field of view 1380 (FIG. 13c).

Alternatively the once the distance 1330 between the two tool 1320 and1310 is smaller than a predetermined distance, the system alerts theuser of said proximity (which might lead to a collision between the twotools). Alternatively, the system moves one of the tools away from theother one.

Example 13 Operator Input Function/Rule

In reference to FIG. 14, which shows, in a non-limiting manner, anembodiment of an operator input function/rule. According to thisembodiment, input is received from the operator.

In the following example, the input received from the operator is whichtool to track.

FIG. 14 a schematically illustrates an endoscope with field of view 1480showing a liver 1410 and two tools 1420 and 1430. A wireless transmitter1460 is enabled to transmit coded instructions through receiver 1470.Operator 1450 first selects the tip of the left tool as the region ofinterest, causing the system to tag (1440) the tip of the left tool.

As illustrated in FIG. 14 b, the system then directs and modifies thespatial position of the endoscope so that the tagged tool tip 1440 is inthe center of the field of view 1480.

Another example of the operator input function/rule is the following:

If a tool has been moved closely to an organ in the surgicalenvironment, according to the proximity rule or the collision preventionrule, the system will, according to one embodiment, prevent the movementof the surgical tool.

According to one embodiment of the present invention, once the surgicaltool has been stopped, any movement of said tool in the direction isinterpreted as input from the operator to continue the movement of saidsurgical tool in said direction.

Thus, according to this embodiment, the operator input function/rulereceives input from the operator (i.e., physician) to continue the moveof said surgical tool (even though it is “against” the collisionprevention rule). Said input is simply in the form of the continuedmovement of the surgical tool (after the alert of the system or afterthe movement prevention by the system).

Example 14 constant Field of View Rule/Function

In reference to FIGS. 15A-D, which shows, in a non-limiting manner, anembodiment of a tracking system with a constant field of viewrule/function.

In many endoscopic systems, the tip lens in the camera optics is not ata right angle to the sides of the endoscope. Conventionally, the tiplens angle is described relative to the right angle, so that a tip lensat right angles to the sides of the endoscope is described as having anangle of 0. Typically, angled endoscope tip lenses have an angle of 30°or 45°. This tip lens angle affects the image seen during zooming. FIG.15 illustrates, in an out-of-scale manner, for a conventional system,the effect of zooming in the field of view in an endoscope with tip lensset straight in the end (FIG. 15A and 15B) vs. the effect of zooming inthe field of view in an endoscope with angled tip lens (FIG. 15C and15D).

FIGS. 15A and 15C illustrate the endoscope (100), the object it isviewing (200) and the image seen by the endoscope camera (130) beforethe zoom. The solid arrows (160) show the limits of the FOV and thedashed arrow (170), the center of the field of view (FOV); since theobject is in the center of the FOV, an image of the object (210) is inthe center of the camera image (130). FIGS. 3B and 3D illustrate theendoscope (100), the object it is viewing (200) and the image seen bythe endoscope camera (130) after the zoom. The solid arrows (160) showthe limits of the FOV and the dashed arrow (170), the center of thefield of view.

If the tip lens is set straight in the end of the endoscope (FIGS. 15Aand 15B), an object (200) in the center of the field of view will be inthe center of the field of view (FOV) (and the camera image) (130) bothbefore (FIG. 15A) and after (FIG. 15B) the zoom. However, if the tiplens is set at an angle in the end of the endoscope (FIGS. 15C and 15D),then an object that is in the center of the FOV (and the camera image)before the zoom (FIG. 15C) will not be in the center of the FOV (or thecamera image) after the zoom (FIG. 15D) since the direction of motion ofthe endo scope is not the direction in which the center of the field ofview (170) points.

In an embodiment of the system of the present invention, unlike inconventional systems, the controlling means maintains the center of thefield of view (FOV) during zoom independent of the tip lens angle. Anadvantage of controlling the zoom of the endoscope via a data processingsystem is that the tip lens angle does not need to be input to the dataprocessing system, obviating a possible source of error.

According to one embodiment of the present invention, the endoscope'smovement will be adjusted in order to maintain a constant field of view.

Example 15 Misalignment Rule/Function

According to another embodiment of the present invention, the system caninform the user of any misalignment of the same system.

Misalignment of the system may cause parasitic movement of the endoscopetip, where the endoscope tip does not move exactly in the expecteddirection. According to one embodiment of the system, the systemcomprises sensors (e.g., gyroscopes, accelometers and any combinationthereof) that calculate/estimates the position of the pivot point inreal time in order to (a) inform the user of misalignment; or (b)calculate the misalignment so that the system can adjust its movement toprevent parasitic movement.

Example 16 Change of Speed Rule/Function

In reference to FIG. 16, which shows, in a non-limiting manner, anembodiment of a tracking system with a change of speed rule/function.

In conventional endoscopic control systems, motion of the endoscopeoccurs at a single speed. This speed is fairly fast so that theendoscope can be moved rapidly between locations that are wellseparated. However, this means that making fine adjustments so difficultthat fine adjustments are normally not made. In an embodiment of thepresent invention, the speed of the tip of the endoscope isautomatically varied such that, the closer the endoscope tip is to anobject, be it a tool, an obstacle, or the object of interest, the moreslowly it moves. In this embodiment, as shown in FIG. 7, measurementsare made of the distance X (150) from the tip (195) of the endoscope(100) to the pivot point of the endoscope (190), where said pivot pointis at or near the surface of the skin (1100) of a patient (1000).Measurements are also made of the distance Y (250) from the tip of theendoscope (195) to the object in the center of the scene of view (200).From a predetermined velocity V_(p), the actual velocity of the tip ofthe endoscope at a given time, V_(act), is calculated from

$V_{act} \propto {\frac{Y}{X}V_{p}}$

Therefore, the closer to the object at the center of the scene of view,the more slowly the endoscope moves, making it possible to use automaticcontrol of even fine adjustments, and reducing the probability that theendoscope will come in contact with tissue or instruments.

In embodiments of the system, the harder the control unit is pressed,the faster the endoscope tip moves. In these embodiments, the systemprovides a warning if the speed is above a predetermined maximum.Examples of the method of warning include, but are not limited to, aconstant volume tone, a constant pitch tone, a varying volume tone, avarying pitch tone, a vocal signal, a constant color visual signal, aconstant brightness visual signal, a varying color visual signal, avarying brightness visual signal, a signal visible on at least some partof the endoscope image, a signal visible on at least some portion of thepatient, a signal visible in at least some portion of the surroundingsof the patient, a vibration in the control unit, a temperature change inthe control unit, and any combination of the above.

According to one embodiment of the present invention, the velocity ofthe endoscope's movement will be adjusted as a function of the distanceof the endoscope's tip from the organ\tissue.

In the foregoing description, embodiments of the invention, includingpreferred embodiments, have been presented for the purpose ofillustration and description. They are not intended to be exhaustive orto limit the invention to the precise form disclosed. Obviousmodifications or variations are possible in light of the aboveteachings. The embodiments were chosen and described to provide the bestillustration of the principals of the invention and its practicalapplication, and to enable one of ordinary skill in the art to utilizethe invention in various embodiments and with various modifications asare suited to the particular use contemplated. All such modificationsand variations are within the scope of the invention as determined bythe appended claims when interpreted in accordance with the breadth theyare fairly, legally, and equitably entitled.

1. A surgical controlling system, comprising: a. at least one surgicaltool adapted to be inserted into a surgical environment of a human bodyfor assisting a surgical procedure; b. at least one location estimatingmeans adapted to real-time locate the 3D spatial position of said atleast one surgical tool at any given time t; c. at least one movementdetection means communicable with a movement's database and with saidlocation estimating means; said movement's database is adapted to storesaid 3D spatial position of said at least one surgical tool at timet_(f) and at time t₀; where t_(f)>t₀; said movement detection means isadapted to detect movement of said at least one surgical tool if the 3Dspatial position of said at least one surgical tool at time t_(f) isdifferent than said 3D spatial position of said at least one surgicaltool at time t₀; and, d. a controller having a processing meanscommunicable with a controller's database, said controller adapted tocontrol the spatial position of said at least one surgical tool; saidcontroller's database is in communication with said movement detectionmeans; wherein said controller's database is adapted to store apredetermined set of rules according to which ALLOWED and RESTRICTEDmovements of said at least one surgical tool are determined, such thateach detected movement by said movement detection means of said at leastone surgical tool is determined as either an ALLOWED movement or as aRESTRICTED movement according to said predetermined set of rules;wherein said predetermined set of rules comprises at least one ruleselected from a group consisting of: most used tool rule, right toolrule, left tool rule, field of view rule, no fly zone rule, a routerule, environmental rule, operator input rule, proximity rule; collisionprevention rule, history-based rule, tool-dependent allowed andRESTRICTED movements rule, preferred volume zone rule, preferred toolrule, movement detection rule, tagged tool rule, change of speed ruleand any combination thereof; wherein at least one of the following isbeing held true (a) said system additionally comprising an endoscope;said endoscope is adapted to provide real-time image of said surgicalenvironment; (b) at least one of said surgical tools is an endoscopeadapted to provide real-time image of said surgical environment.
 2. Thesurgical controlling system according to claim 1, wherein said taggedtool rule comprises means adapted to tag at least one surgical toolwithin said surgical environment and to determine said ALLOWED movementof said endoscope to constantly track the movement of said taggedsurgical tool.
 3. The surgical controlling system according to claim 1,wherein said field of view rule comprises a communicable databasecomprising n 3D spatial positions; n is an integer greater than or equalto 2; the combination of all of said n 3D spatial positions provides apredetermined field of view; said field of view rule is adapted todetermine said ALLOWED movement of said endoscope within said n 3Dspatial positions so as to maintain a constant field of view, such thatsaid ALLOWED movements are movements in which said endoscope is locatedsubstantially in at least one of said n 3D spatial positions, and saidRESTRICTED movements are movements in which the location of saidendoscope is substantially different from said n 3D spatial positions.4. The surgical controlling system according to claim 1, wherein saidpreferred volume zone rule comprises a communicable database comprisingn 3D spatial positions; n is an integer greater than or equal to 2; saidn 3D spatial positions provides said preferred volume zone; saidpreferred volume zone rule is adapted to determine said ALLOWED movementof said endoscope within said n 3D spatial positions and RESTRICTEDmovement of said endoscope outside said n 3D spatial positions, suchthat said ALLOWED movements are movements in which said endoscope islocated substantially in at least one of said n 3D spatial positions,and said RESTRICTED movements are movements in which the location ofsaid endoscope is substantially different from said n 3D spatialpositions.
 5. The surgical controlling system according to claim 9,wherein said preferred tool rule comprises a communicable database, saiddatabase stores a preferred tool; said preferred tool rule is adapted todetermine said ALLOWED movement of said endoscope to constantly trackthe movement of said preferred tool; and any combination thereof.
 6. Thesurgical controlling system according to claim 1, wherein said most usedtool rule comprises a communicable database counting the amount ofmovement of each of said surgical tools; said most used tool rule isadapted to constantly position said endoscope to track the movement ofthe most moved surgical tool.
 7. The surgical controlling systemaccording to claim 1, wherein said movement detection rule comprises acommunicable database comprising the real-time 3D spatial positions ofeach of said surgical tool; said movement detection rule is adapted todetect movement of said at least one surgical tool when a change in said3D spatial positions is received, such that said ALLOWED movements aremovements in which said endoscope is re-directed to focus on the movingsurgical tool.
 8. The surgical controlling system according to claim 1,wherein, in said change of speed rule, said system constantly monitorsthe distance between said endoscope's tip and at least one object withinthe surgical environment, such that the speed of said endoscope variesas a function of said distance; and any combination thereof.
 9. Thesurgical controlling system according to claim 1, wherein said righttool rule is adapted to determine said ALLOWED movement of saidendoscope according to the movement of the surgical tool positioned toright of said endoscope.
 10. The surgical controlling system accordingto claim 1, wherein said left tool rule is adapted to determine saidALLOWED movement of said endoscope according to the movement of thesurgical tool positioned to left of said endoscope.
 11. The surgicalcontrolling system according to claim 1, wherein said route rulecomprises a communicable database storing predefined route in which saidat least one surgical tool is adapted to move within said surgicalenvironment; said predefined route comprises n 3D spatial positions ofsaid at least one surgical tool; n is an integer greater than or equalto 2; said ALLOWED movements are movements in which said at least onesurgical tool is located substantially in at least one of said n 3Dspatial positions of said predefined route, and said RESTRICTEDmovements are movements in which said location of said at least onesurgical tool is substantially different from said n 3D spatialpositions of said predefined route.
 12. The surgical controlling systemaccording to claim 1, wherein said environmental rule comprises acomprises a communicable database; said communicable database adapted toreceive at least one real-time image of said surgical environment and isadapted to perform real-time image processing of the same and todetermine the 3D spatial position of hazards or obstacles in saidsurgical environment; said environmental rule is adapted to determinesaid ALLOWED and RESTRICTED movements according to said hazards orobstacles in said surgical environment, such that said RESTRICTEDmovements are movements in which said at least one surgical tool islocated substantially in at least one of said 3D spatial positions, andsaid ALLOWED movements are movements in which the location of said atleast one surgical tool is substantially different from said 3D spatialpositions; further wherein said hazards or obstacles in said surgicalenvironment are selected from a group consisting of tissue, a surgicaltool, an organ, an endoscope and any combination thereof.
 13. Thesurgical controlling system according to claim 1, wherein said operatorinput rule comprises a communicable database; said communicable databaseis adapted to receive an input from the operator of said systemregarding said ALLOWED and RESTRICTED movements of said at least onesurgical tool; such that said operator input rule converts an ALLOWEDmovement to a RESTRICTED movement and a RESTRICTED movement to anALLOWED movement.
 14. The surgical controlling system according to claim1, wherein at least one of the following is being held true (a) saidinput comprises n 3D spatial positions; n is an integer greater than orequal to 2; wherein at least one of which is defined as ALLOWED locationand at least one of which is defined as RESTRICTED location, such thatsaid ALLOWED movements are movements in which said at least one surgicaltool is located substantially in at least one of said n 3D spatialpositions, and said RESTRICTED movements are movements in which thelocation of said at least one surgical tool is substantially differentfrom said n 3D spatial positions; (b) said input comprises at least onerule according to which ALLOWED and RESTRICTED movements of said atleast one surgical tool are determined, such that the spatial positionof said at least one surgical tool is controlled by said controlleraccording to said ALLOWED and RESTRICTED movements; said predeterminedset of rules comprises at least one rule selected from a groupconsisting of: most used tool, right tool rule, left tool rule, field ofview rule, no fly zone rule, route rule, environmental rule, operatorinput rule, proximity rule; collision prevention rule, preferred volumezone rule, preferred tool rule, movement detection rule, history-basedrule, tool-dependent allowed and RESTRICTED movements rule, and anycombination thereof
 15. The surgical controlling system according toclaim 1, wherein said proximity rule is adapted to define apredetermined distance between at least two surgical tools; said ALLOWEDmovements are movements which are within the range or out of the rangeof said predetermined distance, and said RESTRICTED movements which areout of the range or within the range of said predetermined distance. 16.The surgical controlling system according to claim 1, wherein saidcollision prevention rule is adapted to define a predetermined distancebetween said at least one surgical tool and an anatomical element withinsaid surgical environment; said ALLOWED movements are movements whichare in a range that is larger than said predetermined distance, and saidRESTRICTED movements are movements which is in a range that is smallerthan said predetermined distance; wherein said anatomical element isselected from a group consisting of tissue, organ, another surgical tooland any combination thereof.
 17. The surgical controlling systemaccording to claim 1, wherein said no fly zone rule comprises acommunicable database comprising n 3D spatial positions; n is an integergreater than or equal to 2; said n 3D spatial positions define apredetermined volume within said surgical environment; said no fly zonerule is adapted to determine said RESTRICTED movement if said movementis within said no fly zone and ALLOWED movement if said movement isoutside said no fly zone, such that said RESTRICTED movements aremovements in which said at least one of said surgical tool is locatedsubstantially in at least one of said n 3D spatial positions, and saidALLOWED movements are movements in which the location of said at leastone surgical tool is substantially different from said n 3D spatialpositions.
 18. The surgical controlling system according to claim 1,wherein said history-based rule comprises a communicable databasestoring each 3D spatial position of each of said surgical tool, suchthat each movement of each surgical tool is stored; said history-basedrule is adapted to determine said ALLOWED and RESTRICTED movementsaccording to historical movements of said at least one surgical tool,such that said ALLOWED movements are movements in which said at leastone surgical tool is located substantially in at least one of said 3Dspatial positions, and said RESTRICTED movements are movements in whichthe location of said at least one surgical tool is substantiallydifferent from said n 3D spatial positions.
 19. The surgical controllingsystem according to claim 1, wherein said tool-dependent allowed andRESTRICTED movements rule comprises a communicable database; saidcommunicable database is adapted to store predetermined characteristicsof at least one of said surgical tool; said tool-dependent allowed andRESTRICTED movements rule is adapted to determine said ALLOWED andRESTRICTED movements according to said predetermined characteristics ofsaid surgical tool; such that allowed movements as movements of saidendoscope which tracks said surgical tool having said predeterminedcharacteristics; wherein said predetermined characteristics of saidsurgical tool are selected from a group consisting of: physicaldimensions, structure, weight, sharpness, and any combination thereof.20. The surgical controlling system according to claim 1, wherein saidsystem further comprising a maneuvering subsystem communicable with saidcontroller, said maneuvering subsystem is adapted to spatiallyreposition said at least one surgical tool during a surgery according tosaid predetermined set of rules; further wherein said system is adaptedto alert the physician of said RESTRICTED movement of said at least onesurgical tool; wherein said alert is selected from a group consisting ofaudio signaling, voice signaling, light signaling, flashing signalingand any combination thereof.
 21. The surgical controlling systemaccording to claim 1, wherein at least one of the following is beingheld true (b) said at least one location estimating means are comprises(i) at least one element selected from a group consisting of opticalimaging means, radio frequency transmitting and receiving means, atleast one mark on said at least one surgical tool and any combinationthereof; and, (ii) at least one surgical instrument spatial locationsoftware adapted to estimate said 3D spatial position of said at leastone surgical tool by means of said element;
 22. The surgical controllingsystem according to claim 1, wherein said at least one locationestimating means are an interface subsystem between a surgeon and the atleast one surgical tool, the interface subsystem comprises: (i) at leastone array comprising N regular or pattern light sources, where N is apositive integer; (ii) at least one array comprising M cameras, each ofthe M cameras, where M is a positive integer; (iii) optional opticalmarkers and means for attaching the optical marker to the at least onesurgical tool; and; (iv) a computerized algorithm operable via thecontroller, the computerized algorithm adapted to record images receivedby each camera of each of the M cameras and to calculate therefrom theposition of each of the tools, and further adapted to provideautomatically the results of the calculation to the human operator ofthe interface.
 23. The surgical controlling system according to claim 1,wherein said system further comprising a maneuvering subsystemcommunicable with said controller, said maneuvering subsystem is adaptedto either (a) spatially reposition said at least one surgical toolduring a surgery according to said predetermined set of rules; (b) saidsystem is adapted to alert the physician of said RESTRICTED movement ofsaid at least one surgical tool; wherein said alert is selected from agroup consisting of audio signaling, voice signaling, light signaling,flashing signaling and any combination thereof; (c) any combinationthereof.
 24. A method for assisting an operator to perform a surgicalprocedure, comprising steps of: a. providing a surgical controllingsystem, comprising: (i) at least one surgical tool; (ii) at least onelocation estimating means; (iii) at least one movement detection means;and, (iv) a controller having a processing means communicable with acontroller's database; b. inserting said at least one surgical tool intoa surgical environment of a human body; c. real-time estimating thelocation of said at least one surgical tool within said surgicalenvironment at any given time t; and, d. detecting if there is movementof said at least one surgical tool if the 3D spatial position of said atleast one surgical tool at time t_(f) is different than said 3D spatialposition of said at least one surgical tool at time t₀; e. controllingthe spatial position of said at least one surgical tool within saidsurgical environment by means of said controller; wherein said step ofcontrolling is performed by storing a predetermined set of rules in acontroller's database; said predetermined set of rules comprises ALLOWEDand RESTRICTED movements of said at least one surgical tool, such thateach detected movement by said movement detection means of said at leastone surgical tool is determined as either an ALLOWED movement or as aRESTRICTED movement according to said predetermined set of rules;further comprising a step of selecting said predetermined set of rulesfrom a group consisting of: most used tool, right tool rule, left toolrule, field of view rule, no fly zone rule, a route rule, anenvironmental rule, an operator input rule, a proximity rule; acollision prevention rule, preferred volume zone rule, preferred toolrule, movement detection rule, a history-based rule, a tool-dependentallowed and RESTRICTED movements rule, tagged tool rule, change of speedrule and any combination thereof; wherein at least one of the followingis being held true (a) said system additionally comprising an endoscope;said endoscope is adapted to provide real-time image of said surgicalenvironment; (b) at least one of said surgical tools is an endoscopeadapted to provide real-time image of said surgical environment.
 25. Themethod according to claim 24, wherein said tagged tool rule comprisesmeans adapted to tag at least one surgical tool within said surgicalenvironment and to determine said ALLOWED movement of said endoscope toconstantly track the movement of said tagged surgical tool.
 26. Themethod according to claim 24, wherein said field of view rule comprisesa communicable database comprising n 3D spatial positions; n is aninteger greater than or equal to 2; the combination of all of said n 3Dspatial positions provides a predetermined field of view; said field ofview rule is adapted to determine said ALLOWED movement of saidendoscope within said n 3D spatial positions so as to maintain aconstant field of view, such that said ALLOWED movements are movementsin which said endoscope is located substantially in at least one of saidn 3D spatial positions, and said RESTRICTED movements are movements inwhich the location of said endoscope is substantially different fromsaid n 3D spatial positions.
 27. The method according to claim 24,wherein said preferred volume zone rule comprises a communicabledatabase comprising n 3D spatial positions; n is an integer greater thanor equal to 2; said n 3D spatial positions provides said preferredvolume zone; said preferred volume zone rule is adapted to determinesaid ALLOWED movement of said endoscope within said n 3D spatialpositions and RESTRICTED movement of said endoscope outside said n 3Dspatial positions, such that said ALLOWED movements are movements inwhich said endoscope is located substantially in at least one of said n3D spatial positions, and said RESTRICTED movements are movements inwhich the location of said endoscope is substantially different fromsaid n 3D spatial positions.
 28. The method according to claim 24,wherein said preferred tool rule comprises a communicable database, saiddatabase stores a preferred tool; said preferred tool rule is adapted todetermine said ALLOWED movement of said endoscope to constantly trackthe movement of said preferred tool; and any combination thereof. 29.The method according to claim 24, wherein said most used tool rulecomprises a communicable database counting the amount of movement ofeach of said surgical tools; said most used tool rule is adapted toconstantly position said endoscope to track the movement of the mostmoved surgical tool.
 30. The method according to claim 24, wherein saidmovement detection rule comprises a communicable database comprising thereal-time 3D spatial positions of each of said surgical tool; saidmovement detection rule is adapted to detect movement of said at leastone surgical tool when a change in said 3D spatial positions isreceived, such that said ALLOWED movements are movements in which saidendoscope is re-directed to focus on the moving surgical tool.
 31. Themethod according to claim 24, wherein, in said change of speed rule,said system constantly monitors the distance between said endoscope'stip and at least one object within the surgical environment, such thatthe speed of said endoscope varies as a function of said distance; andany combination thereof.
 32. The method according to claim 24, whereinsaid right tool rule is adapted to determine said ALLOWED movement ofsaid endoscope according to the movement of the surgical tool positionedto right of said endoscope.
 33. The method according to claim 24,wherein said left tool rule is adapted to determine said ALLOWEDmovement of said endoscope according to the movement of the surgicaltool positioned to left of said endoscope.
 34. The method according toclaim 24, wherein said route rule comprises a communicable databasestoring predefined route in which said at least one surgical tool isadapted to move within said surgical environment; said predefined routecomprises n 3D spatial positions of said at least one surgical tool; nis an integer greater than or equal to 2; said ALLOWED movements aremovements in which said at least one surgical tool is locatedsubstantially in at least one of said n 3D spatial positions of saidpredefined route, and said RESTRICTED movements are movements in whichsaid location of said at least one surgical tool is substantiallydifferent from said n 3D spatial positions of said predefined route. 35.The method according to claim 24, wherein said environmental rulecomprises a comprises a communicable database; said communicabledatabase adapted to receive at least one real-time image of saidsurgical environment and is adapted to perform real-time imageprocessing of the same and to determine the 3D spatial position ofhazards or obstacles in said surgical environment; said environmentalrule is adapted to determine said ALLOWED and RESTRICTED movementsaccording to said hazards or obstacles in said surgical environment,such that said RESTRICTED movements are movements in which said at leastone surgical tool is located substantially in at least one of said 3Dspatial positions, and said ALLOWED movements are movements in which thelocation of said at least one surgical tool is substantially differentfrom said 3D spatial positions; further wherein said hazards orobstacles in said surgical environment are selected from a groupconsisting of tissue, a surgical tool, an organ, an endoscope and anycombination thereof.
 36. The method according to claim 24, wherein saidoperator input rule comprises a communicable database; said communicabledatabase is adapted to receive an input from the operator of said systemregarding said ALLOWED and RESTRICTED movements of said at least onesurgical tool; such that said operator input rule converts an ALLOWEDmovement to a RESTRICTED movement and a RESTRICTED movement to anALLOWED movement.
 37. The method according to claim 24, wherein at leastone of the following is being held true (a) said input comprises n 3Dspatial positions; n is an integer greater than or equal to 2; whereinat least one of which is defined as ALLOWED location and at least one ofwhich is defined as RESTRICTED location, such that said ALLOWEDmovements are movements in which said at least one surgical tool islocated substantially in at least one of said n 3D spatial positions,and said RESTRICTED movements are movements in which the location ofsaid at least one surgical tool is substantially different from said n3D spatial positions; (b) said input comprises at least one ruleaccording to which ALLOWED and RESTRICTED movements of said at least onesurgical tool are determined, such that the spatial position of said atleast one surgical tool is controlled by said controller according tosaid ALLOWED and RESTRICTED movements; said predetermined set of rulescomprises at least one rule selected from a group consisting of: mostused tool, right tool rule, left tool rule, field of view rule, no flyzone rule, route rule, environmental rule, operator input rule,proximity rule; collision prevention rule, preferred volume zone rule,preferred tool rule, movement detection rule, history-based rule,tool-dependent allowed and RESTRICTED movements rule, and anycombination thereof
 38. The method according to claim 24, wherein saidproximity rule is adapted to define a predetermined distance between atleast two surgical tools; said ALLOWED movements are movements which arewithin the range or out of the range of said predetermined distance, andsaid RESTRICTED movements which are out of the range or within the rangeof said predetermined distance.
 39. The method according to claim 24,wherein said collision prevention rule is adapted to define apredetermined distance between said at least one surgical tool and ananatomical element within said surgical environment; said ALLOWEDmovements are movements which are in a range that is larger than saidpredetermined distance, and said RESTRICTED movements are movementswhich is in a range that is smaller than said predetermined distance;wherein said anatomical element is selected from a group consisting oftissue, organ, another surgical tool and any combination thereof. 40.The method according to claim 24, wherein said no fly zone rulecomprises a communicable database comprising n 3D spatial positions; nis an integer greater than or equal to 2; said n 3D spatial positionsdefine a predetermined volume within said surgical environment; said nofly zone rule is adapted to determine said RESTRICTED movement if saidmovement is within said no fly zone and ALLOWED movement if saidmovement is outside said no fly zone, such that said RESTRICTEDmovements are movements in which said at least one of said surgical toolis located substantially in at least one of said n 3D spatial positions,and said ALLOWED movements are movements in which the location of saidat least one surgical tool is substantially different from said n 3Dspatial positions.
 41. The method according to claim 24, wherein saidhistory-based rule comprises a communicable database storing each 3Dspatial position of each of said surgical tool, such that each movementof each surgical tool is stored; said history-based rule is adapted todetermine said ALLOWED and RESTRICTED movements according to historicalmovements of said at least one surgical tool, such that said ALLOWEDmovements are movements in which said at least one surgical tool islocated substantially in at least one of said 3D spatial positions, andsaid RESTRICTED movements are movements in which the location of said atleast one surgical tool is substantially different from said n 3Dspatial positions.
 42. The method according to claim 24, wherein saidtool-dependent allowed and RESTRICTED movements rule comprises acommunicable database; said communicable database is adapted to storepredetermined characteristics of at least one of said surgical tool;said tool-dependent allowed and RESTRICTED movements rule is adapted todetermine said ALLOWED and RESTRICTED movements according to saidpredetermined characteristics of said surgical tool; such that allowedmovements as movements of said endoscope which tracks said surgical toolhaving said predetermined characteristics; wherein said predeterminedcharacteristics of said surgical tool are selected from a groupconsisting of: physical dimensions, structure, weight, sharpness, andany combination thereof.
 43. The method according to claim 24, whereinsaid system further comprising a maneuvering subsystem communicable withsaid controller, said maneuvering subsystem is adapted to spatiallyreposition said at least one surgical tool during a surgery according tosaid predetermined set of rules; further wherein said system is adaptedto alert the physician of said RESTRICTED movement of said at least onesurgical tool; wherein said alert is selected from a group consisting ofaudio signaling, voice signaling, light signaling, flashing signalingand any combination thereof.
 44. The method according to claim 24,wherein at least one of the following is being held true (b) said atleast one location estimating means are comprises (i) at least oneelement selected from a group consisting of optical imaging means, radiofrequency transmitting and receiving means, at least one mark on said atleast one surgical tool and any combination thereof; and, (ii) at leastone surgical instrument spatial location software adapted to estimatesaid 3D spatial position of said at least one surgical tool by means ofsaid element;
 45. The method according to claim 24, wherein said atleast one location estimating means are an interface subsystem between asurgeon and the at least one surgical tool, the interface subsystemcomprises: (i) at least one array comprising N regular or pattern lightsources, where N is a positive integer; (ii) at least one arraycomprising M cameras, each of the M cameras, where M is a positiveinteger; (iii) optional optical markers and means for attaching theoptical marker to the at least one surgical tool; and; (iv) acomputerized algorithm operable via the controller, the computerizedalgorithm adapted to record images received by each camera of each ofthe M cameras and to calculate therefrom the position of each of thetools, and further adapted to provide automatically the results of thecalculation to the human operator of the interface.
 46. The methodaccording to claim 24, wherein said system further comprising amaneuvering subsystem communicable with said controller, saidmaneuvering subsystem is adapted to either (a) spatially reposition saidat least one surgical tool during a surgery according to saidpredetermined set of rules; (b) said system is adapted to alert thephysician of said RESTRICTED movement of said at least one surgicaltool; wherein said alert is selected from a group consisting of audiosignaling, voice signaling, light signaling, flashing signaling and anycombination thereof; (c) any combination thereof.